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Raloxifene, Estrogen Act Similarly On Postmenopausal Bone Tissue

Raloxifene has actions on bone tissue that are similar to those observed with estrogen.

Further, the depressive effects of this selective estrogen receptor modulator on bone remodelling are less marked than are the effects observed with alendronate.

These are the findings of a two-year placebo-controlled trial of raloxifene in postmenopausal women by Susan M Ott and colleagues from the Department of Medicine, University of Washington, Seattle, Washington, United States, the Department of Endocrinology, Vrije Universiteit Medical Centre, Amsterdam, The Netherlands, and Eli Lilly and Company, Indianapolis, Indiana, United States.

Raloxifene has earlier been shown to increase bone density. These authors sought to examine the effects of raloxifene on bone tissue by studying bone biopsy specimens before and after two years of raloxifene or placebo therapy.

The women in this study were participants in the double-blind, placebo-controlled, multicentre Multiple Outcomes of Raloxifene Evaluation (MORE) trial. The women from two US and two European sites were included if they consented to a bone biopsy.

Doctors did iliac crest bone biopsies at baseline and after two years, with tetracycline labeling preceding each biopsy. Overall, 65 paired biopsy specimens were evaluated with 25 patients on placebo, 22 patients on raloxifene HC1 (60 mg) and 18 on raloxifene HCl (120 mg) treatment.

Researchers used standard histomorphometry to analyse the specimens. None of the biopsy specimens showed evidence of toxic effects on bone or bone cells or met criteria for osteomalacia.

Biopsy specimens in the placebo and raloxifene groups had the appearance of normal bone, with no evidence of marrow fibrosis or increases in the amount of woven bone or numbers of empty osteocyte lacunae. Compared with the baseline, the bone formation rate (BFR) decreased significantly in both groups on raloxifene treatment.

The change in BFR in the group treated with 120 mg of raloxifene was -62.3 percent, which was significantly lower than the change in the placebo group of -21.0 percent.

No change in resorption parameters could be measured by histomorphometry, but there was a decrease in urinary type I collagen excretion.

These results suggest raloxifene's actions on bone tissue are similar to those observed with estrogen; the depressive effects on bone remodelling are less marked than are the effects seen with alendronate, these authors conclude.
J Bone Miner Res 2002;17:341-348. "Bone Histomorphometric and Biochemical Marker Results of a 2-Year Placebo-Controlled Trial of Raloxifene in Postmenopausal Women"

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