[Effects of SERMs on bone health. The potential of SERM in the care of chronic kidney disease-mineral bone and disorders].

The umbrella concept chronic kidney disease-mineral bone and disorders (CKD-MBD) has been developed these days, which includes vascular calcification, laboratory abnormalities, and bone abnormalities. Given the high prevalence of CKD stage 3 in the patients with osteoporosis and the high risk of fracture in osteoporosis with CKD, the role of raloxifene, one of SERM, in the care of CKD-MBD should not be overlooked. In the post-hoc analysis of the MORE trial, the effect of raloxifene to reduce vertebral fracture was confirmed as well as a positive effect on bone mineral densities in patients with moderate renal failure and normal parathyroid hormone (PTH). However, there is a possibility of this drug increasing PTH level just like other antiresorbing medications. Therefore, concomitant prescription of active vitamin D might be a good solution. From the viewpoint of pharmacokinetics, it is better to reduce the dose of raloxifene in patients with severe CKD. Moreover, it should be remembered not to prescribe this drug in nephrotic syndrome, which is associated with high risk of thrombosis.