Abstract
To evaluate the magnitude of bone loss in postmenopausal women and to study the effect of a selective estrogen Receptor Modulator, raloxifene, on bone loss by quantitative ultrasound of calcaneus and serum bone specific alkaline phosphatase (BAP). Postmenopausal women with ostesopenia/osteoporosis were assigned randomly to receive placebo (n=30) or raloxifene (60mg/d, n=30) with calcium (500mg/day) and vitamin D (250 IU/day). The bone mineral density (BMD) and BAP levels were measured at the beginning of therapy and six months later. They were subjected to statistical analysis (t test, p value) using SPSS statistical package. 70% of postmenopausal women suffered from osteopenia/osteoporosis. After raloxifene therapy, there was improvement in the BMD but this was not statistically significant (p>0.05). There was a fall in the value of serum BAP by 26.6% (p<0.05). Raloxifene has a favourable effect on bone turnover as evident from changes in BMD and a significant fall in serum BAP.
Key Words: Bone mineral density, Bone specific alkaline phosphatase, Quantitative ultra sonography, Dual X Ray Absorptiometry
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References
- 1.Marshall D., Johnell O., Wedel H. Metanalysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ. 1996;312(7041):1254–1259. doi: 10.1136/bmj.312.7041.1254. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Hans D., Dargent-Molina P., Schott A.M., Sebert J.L., Cormier C., Kotzki P.O., et al. Ultrasonographic heel measurements to predict hip fracture in elderly women: The EPIDOS prospective study. Lancet. 1996;348(9026):511–514. doi: 10.1016/S0140-6736(95)11456-4. [DOI] [PubMed] [Google Scholar]
- 3.Lopez-Rodríguez F., Mezquita-Raya P., Dios Luna J., Escobar-Jimenez F., Munoz-Torres M. Performance of quantitative ultrasound in the discrimination of prevalent osteoporotic fractures in a bone metabolic unit. Bone. 2003;32(5):571–578. doi: 10.1016/S8756-3282(03)00058-9. [DOI] [PubMed] [Google Scholar]
- 4.Miller P.D., Baran D.T., Bilezikian J.P., Greenspan S.L., Lindsay R., Riggs B.L., et al. Practical clinical application of biochemical markers of bone turnover: Consensus of an expert panel. J Clin Densitom. 1999;23:323–342. doi: 10.1385/JCD:2:3:323. [DOI] [PubMed] [Google Scholar]
- 5.Garnero P, Delmas PD. Clinical usefulness of markers of bone remodeling in osteoporosis.In meunier PJ, editor.Osteoporosis: Diagnosis and management. London Martin Dunitz Ltd 1998; 79–101.
- 6.Spencer C.P., Morris E.P., Rymer J.M. Selective estrogen receptor modulators: Women’s panacea for the next millennium? Am J Obstet Gynecol. 1999;180:763–769. doi: 10.1016/S0002-9378(99)70285-1. [DOI] [PubMed] [Google Scholar]
- 7.Langton C.M., Langton D.K. Comparison of bone mineral density and quantitative ultrasound of the calcaneus:site matched correlation and discrimination of axial BMD status. Br J Radiol. 2000;73(865):31–35. doi: 10.1259/bjr.73.865.10721317. [DOI] [PubMed] [Google Scholar]
- 8.Bauer D.C., Gluer C.C., Cauley J.A., Vogt T.M., Ensrud K.E., Genant H.K., et al. Broad band ultrasound attenuation predicts fractures strongly and independently of densitometry in older women. A prospective study. Study of Osteoporotic Fractures Research Group. Arch Intern Med. 1997;157(6):629–634. doi: 10.1001/archinte.157.6.629. [DOI] [PubMed] [Google Scholar]
- 9.Delmas P.D., Hardy P., Garnero P., Dain M. Monitoring individual response to hormone replacement therapy with bone markers. Bone. 2000;26(6):553–560. doi: 10.1016/S8756-3282(00)00271-4. [DOI] [PubMed] [Google Scholar]
- 10.Garnero P., Dalmas P.D. Biochemical markers of bone turnover. Applications for osteoporosis. Endocrinol Metab Clin North Am. 1998;27(2):303–323. doi: 10.1016/S0889-8529(05)70007-4. [DOI] [PubMed] [Google Scholar]
- 11.Goldstein S.R. Selective estrogen receptor modulators: a new category of therapeutic agents for extending the health of post menopausal women. Am J Obstet Gynecol. 1998;179(6Pt1):1479–1484. doi: 10.1016/S0002-9378(98)70012-2. [DOI] [PubMed] [Google Scholar]
- 12.Jolly E.E., Bjarnason N.H., Neven P., Plouffe L., Jr, Johnston C.C., Jr, Watts S.D., et al. Prevention of osteoporosis and uterine effects in post menopausal women taking raloxifen for 5 years. Menopause. 2003;10(4):337–344. doi: 10.1097/01.GME.0000058772.59606.2A. [DOI] [PubMed] [Google Scholar]
- 13.Draper M.W., Flowers D.E., Huster W.J., Neild J.A., Harper K.D., Arnaud C. A controlled trial of raloxifene (LY139481) HCl: impact on bone turnover and serum lipid profile in healthy postmenopausal women. J Bone Miner Res. 1996;11(6):835–842. doi: 10.1002/jbmr.5650110615. [DOI] [PubMed] [Google Scholar]
- 14.Chapurlat R.D., Blackwell T., Bauer D.C., Cummings S.R. Changes in biochemical markers of bone turnover in women treated with raloxifene: Influence of regression to the mean. Osteoporos Int. 2001;12(12):1006–1014. doi: 10.1007/s001980170009. [DOI] [PubMed] [Google Scholar]
- 15.Cummings S.R., Eckert S., Krueger K.A., Gardy D., Powles T.J., Cauley J.A., et al. The effect of raloxifene on the risk of breast cancer in post menopausal women:Results from the MORE randomized trial. Multiple Outcomes of Raloxifene Evaluation. JAMA. 1999;281(23):2189–2197. doi: 10.1001/jama.281.23.2189. [DOI] [PubMed] [Google Scholar]
- 16.Barrett-Connor E., Wenger N.K., Grady D., Mosca L., Collins P., Kornitzer M., et al. Hormone and non hormone therapy for the maintenance of postmenopausal health: The need for randomized controlled trials of estrogen and raloxifene. J Womens Health. 1998;7(7):839–847. doi: 10.1089/jwh.1998.7.839. [DOI] [PubMed] [Google Scholar]
- 17.Mosca L., Barrett Connor E., Wegner N.K., Collins P., Grady D., Kornitzer M., et al. Designs and methods of the raloxifene. Use for the Heart (RUTH) Study. Am J Cardiol. 2001;88(4):392–395. doi: 10.1016/S0002-9149(01)01685-X. [DOI] [PubMed] [Google Scholar]