What is the role of selective estrogen receptor modulators (SERMs) in the treatment of menopausal women?

Updated: Jun 06, 2018
  • Author: PonJola Coney, MD; Chief Editor: Richard Scott Lucidi, MD, FACOG  more...
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Answer

Answer

Raloxifene is an SERM that acts directly on estrogen receptors in the bone to decrease resorption. In clinical trials with up to 8 years of follow-up, raloxifene significantly reduced the risk of vertebral, but not nonvertebral, fracture. [36] Raloxifene, tamoxifen, and estrogen all were shown to increase the risk of thromboembolic events. [5]

The combination product of bazedoxifene, a SERM, and conjugated estrogens (CEs) was approved by the FDA in October 2013. Combining a SERM with CEs lowers the risk of uterine hyperplasia caused by estrogens. This eliminates the need for a progestin and its associated risks (eg, breast cancer, MI, VTE). In clinical trials, this combination decreased bone turnover and bone loss in postmenopausal women at risk for osteoporosis. Bone mineral density increased significantly more with all bazedoxifene/CE doses compared with placebo at the lumbar spine and total hip and with most bazedoxifene/CE doses compared with raloxifene at the lumbar spine. [37] Bazedoxifene/CE is FDA-approved for prevention of osteoporosis and treatment of vasomotor symptoms in postmenopausal women.


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