New Osteoporosis Drug

Q.Do you have any information on the new hormone therapy for osteoporosis called Evista?

–Karen

A.”Evista” is the brand name for a new drug called raloxifen. Raloxifen is a selective estrogen receptor modulator (SERM), meaning it acts like estrogen in some parts of the body, but not others. Evista recently won approval from the Food and Drug Administration, but only for the prevention of osteoporosis in postmenopausal women. That’s very important to remember because it is NOT a substitute for estrogen. Instead, it is an alternative for women who cannot take estrogen. Evista, unlike estrogen, has not been approved for prevention of cardiovascular disease, nor has it been evaluated for decreasing the risk of Alzheimer’s, another possible benefit of estrogen.

In studies, Evista was shown to preserve bone mass when compared with a placebo. The amount of bone mass preservation compared favorably with that achieved with estrogen. It was also shown to decrease total cholesterol, which is beneficial, but it did not raise HDL (the “good” cholesterol) as estrogen does. More research needs to be done to show whether this reduction in total cholesterol can improve cardiovascular health in postmenopausal women.

Another potential benefit of Evista is that fact that it does not increase the thickness of the uterine lining; it appears to be an anti-estrogen here, which is good. In studies on mice and rats (not humans!), it has been shown to decrease the rate of estrogen-induced breast cancers. However, on the downside, again in rat and mice studies, raloxifen increased ovarian tumors. It also may make hot flashes worse. Leg cramps are also fairly commonly reported, and a rare, but serious side effect is increased blood clots in legs.

Evista is not a panacea, nor is it a replacement for estrogen. But it is an excellent addition to our arsenal for treating osteoporosis. It is another option for women at risk for osteoporosis who cannot, or will not, take estrogen. The decision to use Raloxifene (Evista) or Alendronate (Fosomax) (another new non-estrogen bone building cheap drug) or estrogen must be made by you and your doctor, taking into account such things as your overall health, family history and symptoms.

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