European Spine Journal

, Volume 21, Issue 12, pp 2407–2417 | Cite as

Recommendations for raloxifene use in daily clinical practice in the Swiss setting

  • Kurt Lippuner
  • P. A. Buchard
  • C. De Geyter
  • B. Imthurn
  • O. Lamy
  • M. Litschgi
  • F. Luzuy
  • K. Schiessl
  • P. Stute
  • M. Birkhäuser
Review Article



Raloxifene is the first selective estrogen receptor modulator that has been approved for the treatment and prevention of osteoporosis in postmenopausal women in Europe and in the US. Although raloxifene reduces the risk of invasive breast cancer in postmenopausal women with osteoporosis and in postmenopausal women at high risk for invasive breast cancer, it is approved in that indication in the US but not in the EU. The aim was to characterize the clinical profiles of postmenopausal women expected to benefit most from therapy with raloxifene based on published scientific evidence to date.


Key individual patient characteristics relevant to the prescription of raloxifene in daily practice were defined by a board of Swiss experts in the fields of menopause and metabolic bone diseases and linked to published scientific evidence. Consensus was reached about translating these insights into daily practice.


Through estrogen agonistic effects on bone, raloxifene reduces biochemical markers of bone turnover to premenopausal levels, increases bone mineral density (BMD) at the lumbar spine, proximal femur, and total body, and reduces vertebral fracture risk in women with osteopenia or osteoporosis with and without prevalent vertebral fracture. Through estrogen antagonistic effects on breast tissue, raloxifene reduces the risk of invasive estrogen-receptor positive breast cancer in postmenopausal women with osteoporosis and in postmenopausal women at high risk for invasive breast cancer. Finally, raloxifene increases the incidence of hot flushes, the risk of venous thromboembolic events, and the risk of fatal stroke in postmenopausal women at increased risk for coronary heart disease. Postmenopausal women in whom the use of raloxifene is considered can be categorized in a 2 × 2 matrix reflecting their bone status (osteopenic or osteoporotic based on their BMD T-score by dual energy X-ray absorptiometry) and their breast cancer risk (low or high based on the modified Gail model). Women at high risk of breast cancer should be considered for treatment with raloxifene.


Postmenopausal women between 50 and 70 years of age without climacteric symptoms with either osteopenia or osteoporosis should be evaluated with regard to their breast cancer risk and considered for treatment with raloxifene within the framework of its contraindications and precautions.


Raloxifene Breast cancer Osteoporosis Fractures 



Dr Philippe Kress, Kressmed, Glattbrugg, Switzerland is acknowledged for editorial assistance.

Conflict of interest

This paper is based on discussions held during a meeting sponsored by an unrestricted educational grant of Daiichi Sankyo Switzerland AG. None of the authors have received any financial support or paid fee for the writing of this review.


  1. 1.
    (2011) Prescribing information for EVISTA® (raloxifene) published in the Swiss Compendium for drugs intended for human use. Accessed 19 August 2011
  2. 2.
    (2007) Prescribing information and approval history of EVISTA® (raloxifene hydrochloride) by the US Food and Drug Administration. Accessed 19 August 2011
  3. 3.
    Ettinger B, Black DM, Mitlak BH, Knickerbocker RK, Nickelsen T, Genant HK, Christiansen C, Delmas PD, Zanchetta JR, Stakkestad J, Gluer CC, Krueger K, Cohen FJ, Eckert S, Ensrud KE, Avioli LV, Lips P, Cummings SR (1999) Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA 282:637–645PubMedCrossRefGoogle Scholar
  4. 4.
    Martino S, Cauley JA, Barrett-Connor E, Powles TJ, Mershon J, Disch D, Secrest RJ, Cummings SR (2004) Continuing outcomes relevant to Evista: breast cancer incidence in postmenopausal osteoporotic women in a randomized trial of raloxifene. J Natl Cancer Inst 96:1751–1761PubMedCrossRefGoogle Scholar
  5. 5.
    Barrett-Connor E, Mosca L, Collins P, Geiger MJ, Grady D, Kornitzer M, McNabb MA, Wenger NK (2006) Effects of raloxifene on cardiovascular events and breast cancer in postmenopausal women. N Engl J Med 355:125–137PubMedCrossRefGoogle Scholar
  6. 6.
    Vogel VG, Costantino JP, Wickerham DL, Cronin WM, Cecchini RS, Atkins JN, Bevers TB, Fehrenbacher L, Pajon ER Jr, Wade JL 3rd, Robidoux A, Margolese RG, James J, Lippman SM, Runowicz CD, Ganz PA, Reis SE, McCaskill-Stevens W, Ford LG, Jordan VC, Wolmark N (2006) Effects of tamoxifen vs raloxifene on the risk of developing invasive breast cancer and other disease outcomes: the NSABP Study of Tamoxifen and Raloxifene (STAR) P-2 trial. JAMA 295:2727–2741PubMedCrossRefGoogle Scholar
  7. 7.
    Siris ES, Harris ST, Eastell R, Zanchetta JR, Goemaere S, Diez-Perez A, Stock JL, Song J, Qu Y, Kulkarni PM, Siddhanti SR, Wong M, Cummings SR (2005) Skeletal effects of raloxifene after 8 years: results from the continuing outcomes relevant to Evista (CORE) study. J Bone Miner Res 20:1514–1524PubMedCrossRefGoogle Scholar
  8. 8.
    Martino S, Disch D, Dowsett SA, Keech CA, Mershon JL (2005) Safety assessment of raloxifene over eight years in a clinical trial setting. Curr Med Res Opin 21:1441–1452PubMedCrossRefGoogle Scholar
  9. 9.
    (1993) Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med 94:646–650Google Scholar
  10. 10.
    Kanis JA, Melton LJ 3rd, Christiansen C, Johnston CC, Khaltaev N (1994) The diagnosis of osteoporosis. J Bone Miner Res 9:1137–1141PubMedCrossRefGoogle Scholar
  11. 11.
    Delmas PD, Ensrud KE, Adachi JD, Harper KD, Sarkar S, Gennari C, Reginster JY, Pols HA, Recker RR, Harris ST, Wu W, Genant HK, Black DM, Eastell R (2002) Efficacy of raloxifene on vertebral fracture risk reduction in postmenopausal women with osteoporosis: four-year results from a randomized clinical trial. J Clin Endocrinol Metab 87:3609–3617PubMedCrossRefGoogle Scholar
  12. 12.
    Kanis JA, Johnell O, Black DM, Downs RW Jr, Sarkar S, Fuerst T, Secrest RJ, Pavo I (2003) Effect of raloxifene on the risk of new vertebral fracture in postmenopausal women with osteopenia or osteoporosis: a reanalysis of the Multiple Outcomes of Raloxifene Evaluation trial. Bone 33:293–300PubMedCrossRefGoogle Scholar
  13. 13.
    Delmas PD, Genant HK, Crans GG, Stock JL, Wong M, Siris E, Adachi JD (2003) Severity of prevalent vertebral fractures and the risk of subsequent vertebral and nonvertebral fractures: results from the MORE trial. Bone 33:522–532PubMedCrossRefGoogle Scholar
  14. 14.
    Kanis JA, Johansson H, Oden A, McCloskey EV (2010) A meta-analysis of the efficacy of raloxifene on all clinical and vertebral fractures and its dependency on FRAX. Bone 47:729–735PubMedCrossRefGoogle Scholar
  15. 15.
    Johnell O, Kanis JA, Black DM, Balogh A, Poor G, Sarkar S, Zhou C, Pavo I (2004) Associations between baseline risk factors and vertebral fracture risk in the Multiple Outcomes of Raloxifene Evaluation (MORE) Study. J Bone Miner Res 19:764–772PubMedCrossRefGoogle Scholar
  16. 16.
    McCloskey EV, Beneton M, Charlesworth D, Kayan K, deTakats D, Dey A, Orgee J, Ashford R, Forster M, Cliffe J, Kersh L, Brazier J, Nichol J, Aropuu S, Jalava T, Kanis JA (2007) Clodronate reduces the incidence of fractures in community-dwelling elderly women unselected for osteoporosis: results of a double-blind, placebo-controlled randomized study. J Bone Miner Res 22:135–141PubMedCrossRefGoogle Scholar
  17. 17.
    Kanis JA, Johansson H, Oden A, McCloskey EV (2009) Bazedoxifene reduces vertebral and clinical fractures in postmenopausal women at high risk assessed with FRAX. Bone 44:1049–1054PubMedCrossRefGoogle Scholar
  18. 18.
    Lippman ME, Cummings SR, Disch DP, Mershon JL, Dowsett SA, Cauley JA, Martino S (2006) Effect of raloxifene on the incidence of invasive breast cancer in postmenopausal women with osteoporosis categorized by breast cancer risk. Clin Cancer Res 12:5242–5247PubMedCrossRefGoogle Scholar
  19. 19.
    Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC, Bauer DC, Genant HK, Haskell WL, Marcus R, Ott SM, Torner JC, Quandt SA, Reiss TF, Ensrud KE (1996) Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet 348:1535–1541PubMedCrossRefGoogle Scholar
  20. 20.
    Black DM, Delmas PD, Eastell R, Reid IR, Boonen S, Cauley JA, Cosman F, Lakatos P, Leung PC, Man Z, Mautalen C, Mesenbrink P, Hu H, Caminis J, Tong K, Rosario-Jansen T, Krasnow J, Hue TF, Sellmeyer D, Eriksen EF, Cummings SR (2007) Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med 356:1809–1822PubMedCrossRefGoogle Scholar
  21. 21.
    Ensrud KE, Stock JL, Barrett-Connor E, Grady D, Mosca L, Khaw KT, Zhao Q, Agnusdei D, Cauley JA (2008) Effects of raloxifene on fracture risk in postmenopausal women: the Raloxifene Use for the Heart Trial. J Bone Miner Res 23:112–120PubMedCrossRefGoogle Scholar
  22. 22.
    Delmas PD, Bjarnason NH, Mitlak BH, Ravoux AC, Shah AS, Huster WJ, Draper M, Christiansen C (1997) Effects of raloxifene on bone mineral density, serum cholesterol concentrations, and uterine endometrium in postmenopausal women. N Engl J Med 337:1641–1647PubMedCrossRefGoogle Scholar
  23. 23.
    Johnston CC Jr, Bjarnason NH, Cohen FJ, Shah A, Lindsay R, Mitlak BH, Huster W, Draper MW, Harper KD, Heath H 3rd, Gennari C, Christiansen C, Arnaud CD, Delmas PD (2000) Long-term effects of raloxifene on bone mineral density, bone turnover, and serum lipid levels in early postmenopausal women: three-year data from 2 double-blind, randomized, placebo-controlled trials. Arch Intern Med 160:3444–3450PubMedCrossRefGoogle Scholar
  24. 24.
    Jolly EE, Bjarnason NH, Neven P, Plouffe L Jr, Johnston CC Jr, Watts SD, Arnaud CD, Mason TM, Crans G, Akers R, Draper MW (2003) Prevention of osteoporosis and uterine effects in postmenopausal women taking raloxifene for 5 years. Menopause 10:337–344PubMedCrossRefGoogle Scholar
  25. 25.
    Reid IR, Eastell R, Fogelman I, Adachi JD, Rosen A, Netelenbos C, Watts NB, Seeman E, Ciaccia AV, Draper MW (2004) A comparison of the effects of raloxifene and conjugated equine estrogen on bone and lipids in healthy postmenopausal women. Arch Intern Med 164:871–879PubMedCrossRefGoogle Scholar
  26. 26.
    Kanis JA, Oden A, Johnell O, Johansson H, De Laet C, Brown J, Burckhardt P, Cooper C, Christiansen C, Cummings S, Eisman JA, Fujiwara S, Gluer C, Goltzman D, Hans D, Krieg MA, La Croix A, McCloskey E, Mellstrom D, Melton LJ 3rd, Pols H, Reeve J, Sanders K, Schott AM, Silman A, Torgerson D, van Staa T, Watts NB, Yoshimura N (2007) The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int 18:1033–1046PubMedCrossRefGoogle Scholar
  27. 27.
    Krieg MA, Cornuz J, Ruffieux C, Van Melle G, Buche D, Dambacher MA, Hans D, Hartl F, Hauselmann HJ, Kraenzlin M, Lippuner K, Neff M, Pancaldi P, Rizzoli R, Tanzi F, Theiler R, Tyndall A, Wimpfheimer C, Burckhardt P (2006) Prediction of hip fracture risk by quantitative ultrasound in more than 7000 Swiss women > or =70 years of age: comparison of three technologically different bone ultrasound devices in the SEMOF study. J Bone Miner Res 21:1457–1463PubMedCrossRefGoogle Scholar
  28. 28.
    Lippuner K, Johansson H, Kanis JA, Rizzoli R (2010) FRAX assessment of osteoporotic fracture probability in Switzerland. Osteoporos Int 21:381–389PubMedCrossRefGoogle Scholar
  29. 29.
    Kanis JA, Johansson H, Oden A, McCloskey EV (2009) Assessment of fracture risk. Eur J Radiol 71:392–397PubMedCrossRefGoogle Scholar
  30. 30.
    Lippuner K, Johansson H, Kanis JA, Rizzoli R (2009) Remaining lifetime and absolute 10-year probabilities of osteoporotic fracture in Swiss men and women. Osteoporos Int 20:1131–1140PubMedCrossRefGoogle Scholar
  31. 31.
    Siris E, Adachi JD, Lu Y, Fuerst T, Crans GG, Wong M, Harper KD, Genant HK (2002) Effects of raloxifene on fracture severity in postmenopausal women with osteoporosis: results from the MORE study. Multiple Outcomes of Raloxifene Evaluation. Osteoporos Int 13:907–913PubMedCrossRefGoogle Scholar
  32. 32.
    Cummings SR, Eckert S, Krueger KA, Grady D, Powles TJ, Cauley JA, Norton L, Nickelsen T, Bjarnason NH, Morrow M, Lippman ME, Black D, Glusman JE, Costa A, Jordan VC (1999) The effect of raloxifene on risk of breast cancer in postmenopausal women: results from the MORE randomized trial. Multiple Outcomes of Raloxifene Evaluation. JAMA 281:2189–2197PubMedCrossRefGoogle Scholar
  33. 33.
    Cummings SR, Duong T, Kenyon E, Cauley JA, Whitehead M, Krueger KA (2002) Serum estradiol level and risk of breast cancer during treatment with raloxifene. JAMA 287:216–220PubMedCrossRefGoogle Scholar
  34. 34.
    Grady D, Cauley JA, Geiger MJ, Kornitzer M, Mosca L, Collins P, Wenger NK, Song J, Mershon J, Barrett-Connor E (2008) Reduced incidence of invasive breast cancer with raloxifene among women at increased coronary risk. J Natl Cancer Inst 100:854–861PubMedCrossRefGoogle Scholar
  35. 35.
    Land SR, Wickerham DL, Costantino JP, Ritter MW, Vogel VG, Lee M, Pajon ER, Wade JL 3rd, Dakhil S, Lockhart JB Jr, Wolmark N, Ganz PA (2006) Patient-reported symptoms and quality of life during treatment with tamoxifen or raloxifene for breast cancer prevention: the NSABP Study of Tamoxifen and Raloxifene (STAR) P-2 trial. JAMA 295:2742–2751PubMedCrossRefGoogle Scholar
  36. 36.
    Fisher B, Costantino JP, Wickerham DL, Redmond CK, Kavanah M, Cronin WM, Vogel V, Robidoux A, Dimitrov N, Atkins J, Daly M, Wieand S, Tan-Chiu E, Ford L, Wolmark N (1998) Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst 90:1371–1388PubMedCrossRefGoogle Scholar
  37. 37.
    Goldstein SR, Duvernoy CS, Calaf J, Adachi JD, Mershon JL, Dowsett SA, Agnusdei D, Stuenkel CA (2009) Raloxifene use in clinical practice: efficacy and safety. Menopause 16:413–421PubMedCrossRefGoogle Scholar
  38. 38.
    Duvernoy CS, Kulkarni PM, Dowsett SA, Keech CA (2005) Vascular events in the Multiple Outcomes of Raloxifene Evaluation (MORE) trial: incidence, patient characteristics, and effect of raloxifene. Menopause 12:444–452PubMedCrossRefGoogle Scholar
  39. 39.
    Blumenthal RS, Baranowski B, Dowsett SA (2004) Cardiovascular effects of raloxifene: the arterial and venous systems. Am Heart J 147:783–789PubMedCrossRefGoogle Scholar
  40. 40.
    Ensrud K, Genazzani AR, Geiger MJ, McNabb M, Dowsett SA, Cox DA, Barrett-Connor E (2006) Effect of raloxifene on cardiovascular adverse events in postmenopausal women with osteoporosis. Am J Cardiol 97:520–527PubMedCrossRefGoogle Scholar
  41. 41.
    Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, Jackson RD, Beresford SA, Howard BV, Johnson KC, Kotchen JM, Ockene J (2002) Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial. JAMA 288:321–333PubMedCrossRefGoogle Scholar
  42. 42.
    Hulley S, Grady D, Bush T, Furberg C, Herrington D, Riggs B, Vittinghoff E (1998) Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen/progestin Replacement Study (HERS) Research Group. JAMA 280:605–613PubMedCrossRefGoogle Scholar
  43. 43.
    Barrett-Connor E, Grady D, Sashegyi A, Anderson PW, Cox DA, Hoszowski K, Rautaharju P, Harper KD (2002) Raloxifene and cardiovascular events in osteoporotic postmenopausal women: four-year results from the MORE (Multiple Outcomes of Raloxifene Evaluation) randomized trial. JAMA 287:847–857PubMedCrossRefGoogle Scholar
  44. 44.
    Barrett-Connor E, Cox DA, Song J, Mitlak B, Mosca L, Grady D (2009) Raloxifene and risk for stroke based on the Framingham stroke risk score. Am J Med 122:754–761PubMedCrossRefGoogle Scholar
  45. 45.
    Riesen W, Darioli R, Noseda G, Bertel O, Buser P (2005) Recommendations for the Prevention of Atherosclerosis. [Empfehlungen zur Prävention der Atherosklerose]. Schweizerische Ärztezeitung 86:1355–1361Google Scholar
  46. 46.
    Assmann G, Schulte H, Cullen P, Seedorf U (2007) Assessing risk of myocardial infarction and stroke: new data from the Prospective Cardiovascular Munster (PROCAM) study. Eur J Clin Invest 37:925–932PubMedCrossRefGoogle Scholar
  47. 47.
    Cooper JA, Miller GJ, Humphries SE (2005) A comparison of the PROCAM and Framingham point-scoring systems for estimation of individual risk of coronary heart disease in the Second Northwick Park Heart Study. Atherosclerosis 181:93–100PubMedCrossRefGoogle Scholar
  48. 48.
    Grady D, Cauley JA, Stock JL, Cox DA, Mitlak BH, Song J, Cummings SR (2010) Effect of Raloxifene on all-cause mortality. Am J Med 123(469):e461–e467Google Scholar
  49. 49.
    Davies GC, Huster WJ, Lu Y, Plouffe L Jr, Lakshmanan M (1999) Adverse events reported by postmenopausal women in controlled trials with raloxifene. Obstet Gynecol 93:558–565PubMedCrossRefGoogle Scholar
  50. 50.
    Aldrighi JM, Quail DC, Levy-Frebault J, Aguas F, Kosian K, Garrido L, Bosio-Le Goux B, Sarachaga M, Graebe A, Nino AJ, Nickelsen T (2004) Predictors of hot flushes in postmenopausal women who receive raloxifene therapy. Am J Obstet Gynecol 191:1979–1988PubMedCrossRefGoogle Scholar
  51. 51.
    Palacios S, Farias ML, Luebbert H, Gomez G, Yabur JA, Quail DC, Turbi C, Kayath MJ, Almeida MJ, Monnig E, Nickelsen T (2004) Raloxifene is not associated with biologically relevant changes in hot flushes in postmenopausal women for whom therapy is appropriate. Am J Obstet Gynecol 191:121–131PubMedCrossRefGoogle Scholar
  52. 52.
    Bundesamt für Gesundheit (BAG) (2011) List of reimbursed medicines in Switzerland (Spezialitätenliste).
  53. 53.
    WHO Study Group on assessment of fracture risk and its application to screening for postmenopausal osteoporosis (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: report of a WHO Study Group. WHO Technical Report Series 843Google Scholar
  54. 54.
    Gail MH, Brinton LA, Byar DP, Corle DK, Green SB, Schairer C, Mulvihill JJ (1989) Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. J Natl Cancer Inst 81:1879–1886PubMedCrossRefGoogle Scholar
  55. 55.
    Gail MH, Costantino JP (2001) Validating and improving models for projecting the absolute risk of breast cancer. J Natl Cancer Inst 93:334–335PubMedCrossRefGoogle Scholar
  56. 56.
    Cummings SR, Black DM, Thompson DE, Applegate WB, Barrett-Connor E, Musliner TA, Palermo L, Prineas R, Rubin SM, Scott JC, Vogt T, Wallace R, Yates AJ, LaCroix AZ (1998) Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA 280:2077–2082PubMedCrossRefGoogle Scholar
  57. 57.
    Cummings SR, San Martin J, McClung MR, Siris ES, Eastell R, Reid IR, Delmas P, Zoog HB, Austin M, Wang A, Kutilek S, Adami S, Zanchetta J, Libanati C, Siddhanti S, Christiansen C (2009) Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med 361:756–765PubMedCrossRefGoogle Scholar
  58. 58.
    Ivergard M, Strom O, Borgstrom F, Burge RT, Tosteson AN, Kanis J (2010) Identifying cost-effective treatment with raloxifene in postmenopausal women using risk algorithms for fractures and invasive breast cancer. Bone 47:966–974PubMedCrossRefGoogle Scholar
  59. 59.
    Johnell O, Scheele WH, Lu Y, Reginster JY, Need AG, Seeman E (2002) Additive effects of raloxifene and alendronate on bone density and biochemical markers of bone remodeling in postmenopausal women with osteoporosis. J Clin Endocrinol Metab 87:985–992PubMedCrossRefGoogle Scholar
  60. 60.
    Diab T, Wang J, Reinwald S, Guldberg RE, Burr DB (2011) Effects of the combination treatment of raloxifene and alendronate on the biomechanical properties of vertebral bone. J Bone Miner Res 26:270–276PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Kurt Lippuner
    • 1
  • P. A. Buchard
    • 2
  • C. De Geyter
    • 3
  • B. Imthurn
    • 4
  • O. Lamy
    • 5
  • M. Litschgi
    • 6
  • F. Luzuy
    • 7
  • K. Schiessl
    • 4
  • P. Stute
    • 8
  • M. Birkhäuser
    • 9
  1. 1.Universitätspoliklinik für Osteoporose, Inselspital BernBernSwitzerland
  2. 2.Clinique romande de réadaptationSionSwitzerland
  3. 3.Klinik für Gynäkologische Endokrinologie und Reproduktionsmedizin, FrauenklinikUniversität BaselBaselSwitzerland
  4. 4.Klinik für Reproduktions–EndokrinologieUniversitätsspitalZurichSwitzerland
  5. 5.Service de Médecine Interne, Département de MédecineCHUVLausanneSwitzerland
  6. 6.Frauenklinik KantonsspitalSchaffhausenSwitzerland
  7. 7.Clinique des GrangettesGeneveSwitzerland
  8. 8.Abteilung für Gynäkologische Endokrinologie und ReproduktionsmedizinUniversitätsklinik für Frauenheilkunde, InselspitalBernSwitzerland
  9. 9.Schweiz. Vereinigung gegen die Osteoporose (SVGO/ASCO)BaselSwitzerland

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