Selective estrogen receptors modulators in the prevention and treatment of postmenopausal osteoporosis.

Raloxifene, the first of the second-generation of SERMs to be widely available, represents a significant improvement over tamoxifen. It prevents postmenopausal bone loss and reduces the incidence of vertebral fractures and of new breast cancer cases in osteoporotic patients without stimulating the endometrium. The suggestion that raloxifene could have a beneficial effect on cardiovascular disease in high-risk patients needs to be confirmed in prospective study. Selective estrogen receptors modulators represent a new and promising class of agents for the management of postmenopausal women with a scope that goes far beyond the prevention and treatment of osteoporosis. The observations that estrogens may play a role in bone metabolism of men and that SERMs prevent bone loss and induce a decrease in total serum cholesterol without affecting the prostate in orchidectomized male rats raises the possibility that they also may be of interest for the treatment of elderly men.