Treating postmenopausal osteoporosis in women at increased risk of fracture – critical appraisal of bazedoxifene: a review

Abstract

Several categories of drugs to treat osteoporosis exist in the form of bisphosphonates, strontium, parathyroid hormone, and selective estrogen receptor modulators (SERM). Advantages and disadvantages exist for each category as some patients may, for example, not tolerate bisphosphonates for gastrointestinal side effects, and especially in women in whom osteoporosis is frequent, several options for treatment are needed. The objectives of this review were to critically appraise the effects of bazedoxifene on risk of fractures especially in women at high risk of fractures. A systematic literature search was conducted for studies, especially randomized controlled trials with fractures as end-points. Bazedoxifene is a new member of the SERM group. The literature search identified one randomized controlled trial with fractures as end-point. This was a 3-year randomized double-blind placebo controlled trial in which 7492 postmenopausal women aged 55 to 85 years were randomly allocated to 1) bazedoxifene (20 [n = 1886] or 40 [n = 1872] mg/day); 2) raloxifene (60 mg/day, n = 1849); or 3) placebo (n = 1885). The risk of vertebral fractures decreased with both 20 (HR 0.58, 95% CI 0.38 to 0.89) and 40 (HR 0.63, 95% CI 0.42 to 0.96) mg of bazedoxifene per day compared to placebo. There was no reduction in non-vertebral fractures. A subgroup of women with a priori high risk of fractures was identified post hoc. In this subgroup there was a reduction in the risk of non-vertebral fractures with the 20 mg dose of bazedoxifene compared to placebo (HR 0.50, 95% CI 0.28 to 0.90). In the 40 mg bazedoxifene group no significant reduction in non-vertebral fractures was seen in this subgroup (HR 0.70, 95% CI 0.40 to 1.20). In general post-hoc defined subgroup analyses should be interpreted with caution. However, the results indicate that bazedoxifene may be effective in preventing vertebral fractures in postmenopausal women with osteoporosis.

The neuroprotective effects of estrogen and estrogenic compounds in spinal cord injury

“…It is also important to note that chronic use of tamoxifen has been associated with increased risk of stroke and thromboembolic events in humans (Braithwaite et al, 2003; Bushnell & Goldstein, 2004; Vogel et al, 2006). Newer generation SERMs, including raloxifene and bazedoxifene, have had some success in overcoming this risk profile, such as reducing the risk of thromboembolic events (Vestergaard & Thomsen, 2009; Vogel et al, 2006). SERM use after SCI, therefore, may also be limited to short-term or prn administration although it is worth noting that raloxifene and bazedoxifene both showed neuroprotective benefit after SCI.…”

Osteonecrose maxilofacial induzida por bisfosfonatos em indivíduos com osteoporose

“…At the menopause, the decrease in estrogen production leads to an imbalance in bone remodeling. Bone reabsorption occurs at a higher rate than bone formation does, which results in progressive bone loss and leads to postmenopausal osteoporosis and increased risk of fractures due to frailness (2) . In postmenopausal women and in men aged 50 years or over, vertebral fractures may occur and may trigger chronic diseases and deformities, both in the hips and femoral head and in the spine, where such fractures are associated with increased morbidity and mortality, and a substantial economic impact (3) .…”