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Osteoporosis Drug a Better HRT?

Evista Offers Promise of Disease Prevention for Older Women
WebMD Health News

June 5, 2003 -- New research is under way to determine if the broken promise of hormone replacement therapy with estrogen and progestins can be fulfilled after all.

The hope is that the osteoporosis drug Evista can lower the risk of breast cancer, heart disease, and osteoporosis in elderly women without increasing their risk for other diseases. Evista is in a class of drugs known as selective estrogen receptor modulators (SERMs).

A study to be published in the July 1 issue of the journal Cancersuggests the Evista investigation may be on the right track: Researchers believe SERM treatment in breast cancer patients may protect them against heart attack.

Lower Heart-Attack Risk

They found that survivors of early breast cancer had a one-third lower risk of heart attack than women without breast cancer. The relationship between lower heart-attack risk in breast cancer survivors was even more significant in women with documented risk factors for heart disease.

The preliminary findings must be confirmed in clinical trials. But lead researcher Elizabeth Lamont, MD, speculates it is not the breast cancer itself, but the treatment for the disease protects against heart disease. The estrogen-modulating drug tamoxifen is the most widely used drug therapy for early-stage breast cancer, and it has also been shown to lower cholesterol levels and protect against osteoporosis.

Tamoxifen and Evista (raloxifene) are both SERMs, meaning they act on some parts of the body that are responsive to the hormone estrogen -- but not all. Evista is considered a more promising drug for prevention of diseases other than breast cancer because it is safer than tamoxifen. Tamoxifen has some estrogen-like effects especially within the uterus and can increase the risk of endometrial cancer.

"Evista lowers LDL cholesterol and does many of the good things tamoxifen does, but it doesn't seem to have the estrogenic tickle that is associated with an increased risk for endometrial cancer," says cancer researcher Craig Jordan, PhD, who developed tamoxifen three decades ago.

"It may be that Evista will protect against all of these diseases of aging, but we have to wait for the clinical evidence." Jordan is director of the Lynn Sage Breast Cancer Research Program at Northwestern University.

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