[Effects of SERMs on bone health. Discrimination of SERMs from bisphosphonates in the treatment of postmenopausal osteoporosis].

Since the aim of the treatment of osteoporosis is to prevent fractures, the first-line drugs must be chosen according to their antifracture efficacies. In postmenopausal women with osteoporosis, alendronate, risedronate, minodronate, and raloxifene are effective in preventing vertebral fractures, and alendronate and risedronate significantly prevent hip fractures. Because the antifracture efficacy of raloxifene against vertebral fractures is considered similar to that of bisphosphonates, the discrimination of raloxifene from bisphosphonates depends on the strategy of doctors (internal medicine, gynecology, and orthopaedics) for preventing vertebral fractures according to the possible side effects of drugs including upper gastrointestinal events, hot flash, and deep vein thromboembolism. Recent reports suggest that patients could be identified who are more responsive to raloxifene than bisphosphonates by evaluating collagen cross-links markers such as homocysteine. Because the incidence of vertebral fractures is higher in Japanese patients, raloxifene plays an important role in the prevention of vertebral fractures in postmenopausal Japanese women with osteoporosis.