Raloxifene

How it works

It acts as an oestrogen agonist on bone, reducing bone resorption and increasing bone mineral density, while behaving as an oestrogen antagonist in breast and uterine tissue.

Prescribing in practice

• It increases the risk of venous thromboembolism and is contraindicated in women with active or past venous thromboembolic disease; it should be stopped during prolonged immobilisation.
• Unlike oestrogen, it does not relieve menopausal vasomotor symptoms and may worsen hot flushes.
• It reduces the incidence of vertebral fractures but has not been shown to reduce non-vertebral or hip fractures.

Monitoring

Assess fracture risk and bone mineral density periodically, and ensure adequate calcium and vitamin D intake.

Counselling the patient

• Report any leg swelling, pain, breathlessness or chest pain promptly as these may signal a clot.
• Tell your team if you are due to have surgery or will be immobile for a prolonged period.
• This medicine does not treat hot flushes and may make them worse.

Evidence & guidelines

The MORE trial demonstrated a reduction in vertebral fracture risk in postmenopausal women with osteoporosis.