title: Effect of raloxifene combined with monofluorophosphate as compared with monofluorophosphate alone in postmenopausal women with low bone mass: a randomized, controlled trial.
abstract: Raloxifene effectively reduces the incidence of vertebral fractures in patients with postmenopausal osteoporosis. Recent data suggest that low-dose monofluorophosphate (MFP) plus calcium reduces the vertebral fracture rate in postmenopausal women with moderate osteoporosis. The objective of this study was to evaluate the combination of raloxifene and MFP in the treatment of postmenopausal women with osteopenia, osteoporosis and severe osteoporosis. A total of 596 postmenopausal women with osteopenia, osteoporosis and severe osteoporosis (mean femoral neck T-score of -2.87 SD) were randomized to treatment with 60 mg/day raloxifene HCl and 20 mg/day fluoride ions (as MFP) or 20 mg/day fluoride and placebo for 18 months. All patients received calcium (1000 mg/day) and vitamin D (500 IU/day) supplements. Changes in bone mineral density (BMD), as primary endpoint, and the rate of osteoporotic fractures and biochemical markers, as secondary endpoints, were assessed. As compared with MFP, raloxifene plus MFP was associated with significantly greater mean increases in the BMD of the femoral neck (1.37% versus 0.33%; P=0.004), total hip (0.89% versus -0.42%; P<0.001) and lumbar spine (8.80% versus 5.47% P<0.001). In the raloxifene plus MFP group, 16 patients sustained 17 osteoporotic fractures, as compared with 22 patients sustaining 34 incident osteoporotic fractures in the MFP group ( P=0.313). One patient in the raloxifene plus MFP group sustained multiple osteoporotic fractures, as compared with eight patients in the MFP group ( P=0.020). MFP alone significantly increased the serum bone alkaline phosphatase (bone ALP) and the urinary C-terminal crosslinking telopeptide of type I collagene (U-CTX). The addition of raloxifene in the combination arm blunted the rise in bone ALP, which remained nevertheless significant, and abolished the increase in U-CTX. The combination of raloxifene with MFP was generally well tolerated. This study demonstrates that, in postmenopausal women with osteopenia, osteoporosis and severe osteoporosis, the combination therapy of raloxifene plus MFP favorably influences the BMD and the bone formation and resorption balance, and may reduce the risk of multiple osteoporotic fractures compared to MFP alone.
authors.affiliation: Bone and Cartilage Metabolism Research Unit, University of Liege, Liege, Belgium. jyreginster@ulg.ac.be
authors.forename: Jean Yves
authors.initials: JY
authors.lastname: Reginster
authors.forename: Dieter
authors.initials: D
authors.lastname: Felsenberg
authors.forename: Imre
authors.initials: I
authors.lastname: Pavo
authors.forename: Jan
authors.initials: J
authors.lastname: Stepan
authors.forename: Juraj
authors.initials: J
authors.lastname: Payer
authors.forename: Heinrich
authors.initials: H
authors.lastname: Resch
authors.forename: Claus C
authors.initials: CC
authors.lastname: Glüer
authors.forename: Dieter
authors.initials: D
authors.lastname: Mühlenbacher
authors.forename: Deborah
authors.initials: D
authors.lastname: Quail
authors.forename: Henry
authors.initials: H
authors.lastname: Schmitt
authors.forename: Thomas
authors.initials: T
authors.lastname: Nickelsen
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000886:Anthropometry; D015519:Bone Density / Q000187:drug effects; D001851:Bone Diseases, Metabolic / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005459:Fluorides / Q000627:therapeutic use*; D050723:Fractures, Bone / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D010710:Phosphates / Q000627:therapeutic use*; D020849:Raloxifene Hydrochloride / Q000627:therapeutic use*; D020845:Selective Estrogen Receptor Modulators / Q000627:therapeutic use*
chemical_list: D010710:Phosphates; D020845:Selective Estrogen Receptor Modulators; C012980:fluorophosphate; D020849:Raloxifene Hydrochloride; D005459:Fluorides