Results of systematic review s and meta-analyses of r and omized controlled trials have shown that both systemic estrogen therapy or hormone therapy ( estrogen combined with a progestin ) are useful to prevent bone loss , and they are the most effective treatment for such climacteric symptoms as hot flushes , sweating , vaginal dryness , and dyspareunia .
The combination of a SERM with estrogen as a tissue selective estrogen complex ( TSEC ) is a new strategy for the prevention of bone loss and the treatment of climacteric symptoms .
This combination is particularly interesting from a clinical point of view , taking into account that estrogen alone did not increase breast cancer risk by the Women 's Health Initiative .
TSEC is hypothesized to provide the benefits of estrogen-alone therapy , with an improved tolerability profile because the SERM component can make possible the elimination of progestin .
The conclusion is that effectively , the combination of bazedoxifene and conjugated estrogens may be a promising alternative to hormone therapy for the prevention of osteoporosis and the treatment of postmenopausal symptoms in non-hysterectomized postmenopausal women
Decreasing levels of estrogens during menopause are associated with reduced bone density and an increased risk of osteoporosis .
Many women also experience bothersome vasomotor and vaginal symptoms during the menopausal transition .
Unfortunately , estrogen therapy and hormone therapy increase the risk of endometrial and breast cancer , respectively .
The selective estrogen receptor modulators ( SERMs ) result in positive estrogenic effects on bone , with no negative effects on the endometrium and breast but do not provide relief from postmenopausal symptoms .
The objective of this review was to critically evaluate the evidence from the reports published to date on the use of bazedoxifene ( a third-generation SERM ) in combination with conjugated estrogens in postmenopausal women .
Relationship of early changes in bone resorption to the reduction in fracture risk with risedronate.
Changes in the level of biochemical markers of bone resorption with risedronate treatment for osteoporosis were examined as a surrogate for the decrease in fracture risk . Greater decreases in bone resorption markers were associated with greater decreases in vertebral ( and nonvertebral ) fractures . Antifracture efficacy of antiresorptive therapies is only partially explained by increases in bone mineral density . Early decreases in bone resorption may also play a role . We tested this hypothesis by measuring two bone resorption markers , the C-telopeptide of type I collagen ( CTX ) and the N-telopeptide of type I collagen ( NTX ) , in osteoporotic patients in risedronate vertebral fracture trials . We studied 693 women with at least one vertebral deformity ( mean age , 69 + /- 7 years ) who received calcium ( and vitamin D if required ) and placebo or risedronate 5 mg daily for 3 years . The reductions in urinary CTX ( median , 60 % ) and NTX ( 51 % ) at 3 - 6 months with risedronate therapy were significantly associated ( p < 0.05 ) with the reduction in vertebral fracture risk ( 75 % over 1 year and 50 % over 3 years ) . The changes in both CTX and NTX accounted for approximately one-half ( CTX , 55 % ; NTX , 49 % ) of risedronate 's effect in reducing the risk of vertebral fractures in the first year and approximately two-thirds ( CTX , 67 % ; NTX , 66 % ) over 3 years compared with placebo . The changes in CTX and NTX accounted for 77 % and 54 % , respectively , of risedronate 's effect in reducing the risk of nonvertebral fractures over 3 years compared with placebo . The relationships between vertebral fracture risk and changes from baseline in CTX and NTX were not linear ( p < 0.05 ) . There was little further improvement in fracture benefit below a decrease of 55 - 60 % for CTX and 35 - 40 % for NTX . The decrease in bone resorption in patients taking risedronate accounts for a large proportion of the reduction in fracture risk . There may be a level of bone resorption reduction below which there is no further fracture benefit
Results of systematic review s and meta-analyses of r and omized controlled trials have shown that both systemic estrogen therapy or hormone therapy ( estrogen combined with a progestin ) are useful to prevent bone loss , and they are the most effective treatment for such climacteric symptoms as hot flushes , sweating , vaginal dryness , and dyspareunia .
The combination of a SERM with estrogen as a tissue selective estrogen complex ( TSEC ) is a new strategy for the prevention of bone loss and the treatment of climacteric symptoms .
This combination is particularly interesting from a clinical point of view , taking into account that estrogen alone did not increase breast cancer risk by the Women 's Health Initiative .
TSEC is hypothesized to provide the benefits of estrogen-alone therapy , with an improved tolerability profile because the SERM component can make possible the elimination of progestin .
The conclusion is that effectively , the combination of bazedoxifene and conjugated estrogens may be a promising alternative to hormone therapy for the prevention of osteoporosis and the treatment of postmenopausal symptoms in non-hysterectomized postmenopausal women
Decreasing levels of estrogens during menopause are associated with reduced bone density and an increased risk of osteoporosis .
Many women also experience bothersome vasomotor and vaginal symptoms during the menopausal transition .
Unfortunately , estrogen therapy and hormone therapy increase the risk of endometrial and breast cancer , respectively .
The selective estrogen receptor modulators ( SERMs ) result in positive estrogenic effects on bone , with no negative effects on the endometrium and breast but do not provide relief from postmenopausal symptoms .
The objective of this review was to critically evaluate the evidence from the reports published to date on the use of bazedoxifene ( a third-generation SERM ) in combination with conjugated estrogens in postmenopausal women .