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Old 06-12-2011
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Bones Which drug to prevent further osteoporosis in this lady!

A 52-year-old woman presents to her physician for a check-up. She is recovering from a wrist fracture after a fall. Dual energy x-ray absorptiometry of the hip had shown her to have osteoporosis. She became menopausal at age 50 and did not begin hormone replacement therapy because of a strong family history of breast cancer. She now fears a future hip fracture and would like to begin a bone loss prevention regime. Which of the following pharmaceutical agents is most appropriate for this patient?
A. Calcitonin nasal spray
B. Oral conjugated estrogen
C. Raloxifene
D. Tamoxifen
E. Transdermal estradiol
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Old 06-12-2011
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C) Raloxifine

Selective Estrogen agonist/antagonist that is an agonist at bone but an antagonist at the breast and endometrium

Tamoxifen is an antagonist at breast but an agonist on bone and endometrium so it has an increased risk of endometrial cancer
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Old 06-12-2011
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I'll go for Calcitonin Nasal Spray. Conrad Fischer told that in one of his lectures.
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Quote:
Originally Posted by vaibhavmanu View Post
I'll go for Calcitonin Nasal Spray. Conrad Fischer told that in one of his lectures.
This patient also has risk/concern for breast cancer so the best option would probably be Raloxifene because it decreases risk of breast cancer as well as treating the ostoeporosis.

Although I agree calcitonin could help, I don't think it is the best choice in this particular question.
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i would also go with raloxifene --SERM because of efficacy of lowering the chance of breast/endometrial cancer ....
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Old 06-12-2011
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Quote:
Originally Posted by apx85 View Post
This patient also has risk/concern for breast cancer so the best option would probably be Raloxifene because it decreases risk of breast cancer as well as treating the ostoeporosis.

Although I agree calcitonin could help, I don't think it is the best choice in this particular question.
Yeah I guess that's more important. Totally agree with you.
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Old 06-12-2011
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Correct answer is C > Raloxifene

Prevent Osteoporosis and Endometrial Ca.
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Old 06-12-2011
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Raloxifene It is used only for postmenopausal women. i wounder if it useful as she became menopausal at age 50 and did not begin hormone replacement therapy
i think such therapy should start at the time of menopause and if it's not use early it will not be useful can anyone tell me ?
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the key is the increased danger for breast cancer...i m between c and d..probably d

Raloxifene — Raloxifene is currently used for the prevention and treatment of osteoporosis in postmenopausal women. Several studies suggest that in postmenopausal women at high risk of developing breast cancer, raloxifene can reduce the risk of developing an invasive hormonally-responsive (ER positive) breast cancer.
Raloxifene was directly compared to tamoxifen in a large trial involving postmenopausal women at high risk of breast cancer (called the Study of Tamoxifen and Raloxifene, or STAR trial). Tamoxifen was more effective than raloxifene at preventing invasive breast cancer but also had more side effects [2]. However, raloxifene has only been tested in postmenopausal women; its benefit in premenopausal women is unknown.

uptodate

so its C

Last edited by MANIAKOS; 06-13-2011 at 01:06 AM.
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I not sure, but I think is c
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Old 06-12-2011
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Quote:
Originally Posted by Claus_CU View Post
I not sure, but I think is c
Guys, answer is C) Raloxifene forsure, Goljan explains it in his audio..

It will selectively block Estrogen receptors in breast (ERP Breast Cancer), while not affecting those in bone so it will prevent osteoporosis.
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Old 06-13-2011
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the answer is C
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Old 06-23-2011
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good comparison table (Kaplan)

Which drug to prevent further osteoporosis in this lady!-screen-shot-2011-06-23-2.15.28-pm.png
click image to enlarge
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