title: Profile of bazedoxifene/conjugated estrogens for the treatment of estrogen deficiency symptoms and osteoporosis in women at risk of fracture.
abstract: 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. Results of systematic reviews and meta-analyses of randomized 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. 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 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 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. 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.
authors.affiliation: Department of Medicine, Rheumatology Unit, University of Verona, Italy. maurizio.rossini@univr.it
authors.forename: Maurizio
authors.initials: M
authors.lastname: Rossini
authors.forename: Stefano
authors.initials: S
authors.lastname: Lello
authors.forename: Ignazio
authors.initials: I
authors.lastname: Sblendorio
authors.forename: Ombretta
authors.initials: O
authors.lastname: Viapiana
authors.forename: Elena
authors.initials: E
authors.lastname: Fracassi
authors.forename: Silvano
authors.initials: S
authors.lastname: Adami
authors.forename: Davide
authors.initials: D
authors.lastname: Gatti
mesh_terms: D000369:Aged, 80 and over; D015519:Bone Density / Q000187:drug effects; D016723:Bone Remodeling; D002986:Clinical Trials as Topic; D004967:Estrogens / Q000172:deficiency*; D004966:Estrogens, Conjugated (USP) / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007211:Indoles / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy*; D058866:Osteoporotic Fractures / Q000517:prevention & control; D011788:Quality of Life; D020845:Selective Estrogen Receptor Modulators / Q000627:therapeutic use*
chemical_list: D004967:Estrogens; D004966:Estrogens, Conjugated (USP); D007211:Indoles; D020845:Selective Estrogen Receptor Modulators; C447119:bazedoxifene
keywords: bone mineral density; bone turnover markers; climacteric symptoms; menopause; tissue selective estrogen complex
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