7/11/2019 I have nothing to disclose Selective Estrogen Receptor - - PowerPoint PPT Presentation

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Selective Estrogen Receptor Modulators (Raloxifene)

Tiffany Kim, MD Assistant Professor of Medicine San Francisco VA Health Care System University of California, San Francisco

I have nothing to disclose

Thanks to Clifford Rosen and Steven Cummings for select slides

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Raloxifene has less effect on BMD than alendronate

Recker, Bone 2007

SERMs and breast cancer

• 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

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Bazedoxifene + CEE (Duavee)

• Combination: estrogen (tx hot flushes) and

SERM (neutral on breast, antagonist at uterus), avoids progestin SE

– An option for hot flushes in a postmenopausal women with a uterus, osteoporosis prevention

• 25-40% decrease in hot flushes vs. placebo
• Improves BMD a little more than SERM, a

little less than the comparable dose of CEE

• Limited fracture data, long-term safety

Summary

• Raloxifene:

– There are more effective drugs for reducing risk

• f fracture

– Consider in a woman with low risk of VTE and for whom bisphosphonates or denosumab are not appropriate – Consider in a women with osteoporosis and at increased risk of breast cancer

• BZA + CEE is an alternative for hot flushes

in postmenopausal women with a uterus