Re: Evista
From: Steve & Eryl Raymond (eryl@intekom.co.za)
Tue Nov 30 11:08:39 2004
Raloxifene is NOT oestrogen. It is a Selective (o)Estrogen Receptor
Modulator (SERM) and like its big sister clomiphene actually blocks
oestrogen by competing for the receptor sites. No wonder she had all
the signs of oestrogen deficiency. If the patient needs oestrogen then
give her oestrogen. But why someone premenopausally should need
oestrogen is a total mystery. Ovarian production of oestrogen is
several times higher than exogenous treatment. The NORA paper you
quote, Douglas, can only apply to postmenopausal women.
Steve
Braun, R. Daniel wrote:
> <>That is a side effect of raloxiphene
>
> R. Daniel Braun, MD
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net On Behalf Of Richard Chudacoff, MD
> Sent: Monday, November 29, 2004 2:49 PM
> Subject: RE: Evista
>
> My point exactly. The patient today was complaining of smaller breasts
> and there was evidence of vaginal atrophy, despite regular cyclic menses.
>
> Richard Chudacoff, MD
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net On Behalf Of Braun, R. Daniel
> Sent: Monday, November 29, 2004 1:21 PM
> Subject: RE: Evista
>
> But shouldn't the premenopausal patients estrogen do everything that
> raloxiphene does for the bone?
>
> R. Daniel Braun, MD
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net On Behalf Of Douglas Krell
> Sent: Monday, November 29, 2004 12:59 PM
> Subject: RE: Evista
>
> Richard, Ana et al...,
>
> While there are no indications for the use of Evista in premenopausal
> women (raloxifene competes with endogenous estrogen for estrogen receptor
> binding sites), the use of raloxifene for the treatment of osteopenia in
> postmenopausal women is an important strategy in the scheme of the
> ultimate goal of preventing fractures in women due to bone loss .
>
> The National Osteoporosis Foundation as well the International
> Osteoporosis Foundation recommends treatment with raloxifiene for
> women with
> demonstrated osteopenia when there are two additional risk factors for
> osteoporosis
> present; Family history, caucasian, smoking, low calcium intake, body
> weight under 125lbs....just about all of our patients. These
> recommendations
> are published on their web sites
>
> The NORA (National Osteoporosis Risk Assessment) trial recently
> published with over 200,000 women studied in outpatient settings found
> that of the
> women who suffered a fracture, over 80% had OSTEOPENIA...not
> osteoporosis. So there is some reason to consider treating these women.
>
> Moreover, raloxifiene is the only therapy I'm aware of that has been
> proven to prevent fracture in randomized, doubly blinded trials when
> studied
> prospectively in the patient with osteopenia. Everyone else has only
> BMD data.
>
> Douglas Krell MD FACOG
>
>> <>From: "Richard Chudacoff, MD" <rchudacoff@mylinuxisp.com>
>> Date: Mon, 29 Nov 2004 09:32:33 -0600
>>
>> Is there any indication for Evista in premenopausal women? I have two
>> patients from the same FP now, who is giving it for osteopenia (not a
>> condition I recognize as needing treatment.)
>>
>> Richard Chudacoff,
>>
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