Takami Miki, Shimada Hiroyuki
Geriatric Medicine, Post Graduate School of Medicine, Osaka City University Medical School.
Clin Calcium. 2010 Mar;20(3):365-71.
Raloxifene is the only SERM available in Japan. The effect on bone metabolism is relatively mild and slow compared with that of bisphosphonates, and reaches plateau after 6th month or later. As diurnal variations of metabolic markers, especially urinary markers are large, it is often difficult to confirm the effect of raloxifen on bone by individual base. The strict sampling time before and after treatment, and/or selection of patients with high turnover bone may help to increase the chance to confirm the raloxifene effect. A new type of SERM bone marker such as tartrate resistant acid phosphatase fraction 5b is expected to improve the chance. Some papers suggest the relation between suppression of bone markers by raloxifene and vertebral fractures, but the relation is not usually confirmed due to wide variations of the markers.
雷洛昔芬是日本唯一可用的选择性雌激素受体调节剂（SERM）。与双膦酸盐相比，其对骨代谢的作用相对温和且缓慢，在6个月或更晚后达到平台期。由于代谢标志物尤其是尿标志物的昼夜变化很大，通常很难逐个确认雷洛昔芬对骨骼的作用。严格的治疗前后采样时间，和/或选择骨转换率高的患者可能有助于增加确认雷洛昔芬效果的机会。一种新型的SERM骨标志物，如抗酒石酸酸性磷酸酶5b，有望提高这种机会。一些论文表明雷洛昔芬对骨标志物的抑制与椎体骨折之间存在关联，但由于标志物的广泛变化，这种关联通常未得到证实。
