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Raloxifene Reverses Bone Loss in Postmenopausal Women with Mild Asymptomatic Primary Hyperparathyroidism

RALOXIFENE IS a selective estrogen receptor modulator (SERM) acting as a tissue-specific estrogen receptor agonist on bone and lipid metabolism and as an estrogen antagonist in the breast and uterus, currently approved for both prevention and treatment of postmenopausal osteoporosis in the United States and Europe. It has been shown to reduce the incidence of vertebral fractures (1) and of breast cancer (1) in osteoporotic women. Here, we report the effects of 12 months of treatment with raloxifene, 60 mg/day or 120 mg/day, on lumbar spine and femur neck bone mineral density (BMD) and biochemical parameters in 3 postmenopausal osteopenic women (mean age, 64; range 59–67 years; mean lumbar spine T score, 21.92) with mild, asymptomatic primary hyperparathyroidism. Patients were experiencing rapid bone loss during the last 2 years (Fig. 1). Treatment with raloxifene was considered because they refused either parathyroid surgery or hormone replacement therapy. Options and treatment characteristics were discussed with the patients and they gave their consent to treatment. BMD increased by 3.4% at lumbar spine and by 2.5% at femur neck after 12 months of treatment (Fig. 1). The effects of treatment on biochemical parameters are shown in Table 1. Total calcium and phosphate levels decreased in all the patients after 12 months of treatment. On the other hand, ionized calcium and intact parathyroid hormone (iPTH) levels showed a decrease after 6 months of treatment, but returned close to baseline values at month 12. Deoxypyridinoline excretion, a specific marker of bone resorption, decreased by 33% after 6 months and by 61% after 12 months; fasting calcium excretion was 39% lower at 6 months and 56% lower at 12 months. Serum total alkaline phosphatase, a marker of osteoblast function, showed only a slight decrease. The apparently different effects of raloxifene on serum total and ionized calcium levels found in our patients also has been noted with hormone replacement therapy in both postmenopausal women with mild primary hyperparathyroidism and normal, early postmenopausal women. (3)