7/11/2019 I have nothing to disclose Selective Estrogen Receptor Modulators (Raloxifene) Tiffany Kim, MD Thanks to Clifford Rosen and Steven Cummings for select slides Assistant Professor of Medicine San Francisco VA Health Care System University of California, San Francisco 1
7/11/2019 Raloxifene has less effect on BMD SERMs and breast cancer than alendronate • Some SERMs block estrogen receptors in breast • Decrease the risk of estrogen sensitive (ER+) breast cancer USPSTF: assess the risk of breast cancer in women ≥ age 50 and consider chemoprevention in those with >3% 5-year risk of breast cancer Recker, Bone 2007 2
7/11/2019 Summary Bazedoxifene + CEE (Duavee) • Raloxifene: • Combination: estrogen (tx hot flushes) and – There are more effective drugs for reducing risk SERM (neutral on breast, antagonist at uterus), of fracture avoids progestin SE – Consider in a woman with low risk of VTE and – An option for hot flushes in a postmenopausal for whom bisphosphonates or denosumab are not women with a uterus, osteoporosis prevention appropriate – Consider in a women with osteoporosis and at • 25-40% decrease in hot flushes vs. placebo increased risk of breast cancer • Improves BMD a little more than SERM, a little less than the comparable dose of CEE • BZA + CEE is an alternative for hot flushes • Limited fracture data, long-term safety in postmenopausal women with a uterus 3
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