National Institute on Aging, National Institutes of Health, Gateway Building, Suite 3E327, Bethesda, Maryland 20892, USA
Address for correspondence: Sherry Sherman, Ph.D., National Institute on Aging, NIH, Gateway Building, Suite 3E327, Bethesda, MD 20892-9205. Courier/express mail ZIP 20814. Voice: 301-435-3048; fax: 301-402-1784.
shermans{at}nia.nih.gov
Osteoporosis has been defined as "a progressive systemic disease
characterized by low bone density and microarchitectural deterioration
of bone tissue, with a consequent increase in bone fragility
and susceptibility to fracture." Osteoporosis and the consequences
of compromised bone strength—particularly vertebral and
hip fractures—are a significant cause of frailty, and
increased morbidity and even mortality and hence are a serious
and costly public health problem in the elderly population However,
due to remarkable advances in basic and clinical research and
in drug design, development, and testing, a number of efficacious,
evidence-based options are available for the prevention and
treatment of osteoporosis. These options extend far beyond estrogen/progestin
therapy and include lifestyle and dietary changes such as increasing
weight-bearing activity, enhancing calcium and vitamin D intake,
as well as incorporating pharmacologic agents such as the bisphosphonates
and selective estrogen receptor modulators (SERMs) such as raloxifene.
In addition to its efficacy in increasing bone mineral density
and reducing vertebral fractures by almost 40% in women with
osteoporosis, the SERM raloxifene appears to promote a cardioprotective
profile and to offer some protection against breast cancer.
The potential of raloxifene to prevent or delay the development
of a number of chronic diseases of aging such as osteoporosis,
cardiovascular disease, and perhaps even Alzheimer's disease
has stimulated the development and refinement of subsequent
generations of SERMs aimed at maximizing beneficial effects
in a wide variety of tissues while eliminating deleterious outcomes
and side effects.
