Oestrogen and selective oestrogen receptor modulators (SERMs): current roles in the prevention and treatment of osteoporosis

Post-menopausal oestrogen replacement therapy (HRT) is the agent of choice for restraint of post-menopausal bone loss. In numerous observational, and in a few intervention studies, it has been shown to reduce osteoporotic fractures. However, in order to be effective treatment has to be carried on long term. This is a task not easily achieved due to poor patient adherence. The majority of patients stop treatment after a few months. Fear of breast cancer and refusal to tolerate resumption of cyclic withdrawal bleeding are the principal objections. Newer and more user-friendly forms of treatment are needed. Ideally, these should have an efficacy similar to oestrogen on the central nervous system, cardiovascular system and bone, without adverse effects on the breast and uterus. With this in mind, Selective oestrogen Receptor Modulators (SERMs) have been developed. In this chapter we review how effective modern pharmacology has been in achieving an improved design of hormonal replacement for the post-menopausal women, and the place that it has obtained today alongside both older and newer forms of treatment.