Effects of Raloxifene on Bone Metabolism in Hemodialysis Patients

Saito et al. (1) reported that raloxifene (RAL) suppressed bone turnover and increased the quantitative ultrasound (QUS) parameter, speed of sound (SOS) of the calcaneus in hemodialysis postmenopausal women with type 2 diabetes or without type 2 diabetes. Baseline bone turnover markers like serum cross-linked N-terminal telopeptides of type I collagen (NTX) and bone-specific alkaline phosphatase (BAP) indicated high bone turnover in hemodialysis postmenopausal women, and the response of these bone turnover markers to RAL treatment did not differ significantly between diabetic and non-diabetic patients. No adverse events were detected in any patients. Thus, RAL was suggested to be beneficial in improving bone turnover and bone mass in hemodialysis postmenopausal women regardless of the presence of type 2 diabetes. However, owing to the small sample size and short duration of observation (one year), the incidence of fragility fractures was not assessed. Hemodialysis patients (chronic kidney disease [CKD] stage 5) have renal osteodystrophy, reflecting increased bone turnover caused by secondary hyperparathyroidism. Bone turnover is further increased in hemodialysis postmenopausal women compared with hemodialysis men because of the menopause-related increase in bone turnover. Although bone formation may be decreased in diabetic patients as indicated by low serum insulin-like growth factor-I (IGF-I) and osteocalcin concentrations (24), hemodialysis postmenopausal women showed high bone turnover similarly in patients with or without type 2 diabetes in the study conducted by Saito et al. (1) so that the effect of RAL on bone turnover markers was similar in diabetic and non-diabetic patients. Osteoporosis most commonly affects postmenopausal women, placing them at a significant risk of fractures. RAL is widely used for the treatment of postmenopausal osteoporosis. The Multiple Outcomes of Raloxifene Evaluation (MORE) study, a double-blind, placebo-controlled randomized clinical trial encompassing 7705 postmenopausal women (aged 31–80 years) with osteoporosis, has shown that RAL increases bone mineral density (BMD) at the spine and femoral neck and reduces the risk of vertebral fracture in women with postmenopausal osteoporosis (5). Short stature, age, years since menopause, impaired cognitive function, visuospatial capabilities, impaired musculoskeletal strength, low femoral neck Publish by Kowsar Corp. All rights reserved.