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Ruolo del raloxifene nella prevenzione e terapia dell’osteoporosi post-menopausale

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Il ventaglio dei farmaci oggi disponibili per la prevenzione e la terapia dell’osteoporosi post-menopausale si è ampliato con l’introduzione del raloxifene, il più studiato fra i compost i appartenenti alla classe dei SERM (selective estrogen receptor modulators). La caratteristica di questi farmaci è di modulare i recettori estrogenici in modo da agire come es trogen i o antiestrogeni a seconda del tessuto bersaglio. Le potenziali implicazioni del loro impiego a lungo termine per la salute della donna in menopausa sono quindi molteplici e complesse. Gli studi condotti in modelli animali ed in campo umano hanno infatti dimostrato come il raloxifene sia efficace nel preservare la densità minerale ossea, nel ridurre i marcatori di turnover osseo e l’incidenza di fratture vertebrali. L’effetto del raloxifene è sovrapponibile nei vari segmenti ossei, suggerendo una azione del farmaco sull’osso corticale e trabecolare, a differenza degli estrogeni che forniscono migliori risultati a livello vertebrale. Molto promettenti sono i dati relativi alla sicurezza oncologica del raloxifene, che ha dimostrato un effetto protettivo sul rischio di sviluppare una neoplasia ormonodipendente della mammella ed un effetto neutro, se non di protezione, sulla proliferazione dell’endometrio. Tali dati hanno costituito la base per iniziare studi di chemioprevenzione del carcinoma mammario in donne a rischio con questo preparato. Favorevole è anche l’effetto sul metabolismo lipidico, sebbene non siano ancora disponibili i dati sull’efficacia del preparato nel ridurre l’incidenza di patologie coronariche. D’altra parte il raloxifene non è di alcuna utilityà per alleviare i più comuni problemi della carenza estrogenica in menopausa, come i sintomi vasomotori e la secchezza vaginale. Per le sue peculiarità di effetti ed allo stato attuale delle conoscenze il raloxifene ha quindi oggi un ben preciso posizionamento nell’ambito della prevenzione e della terapia dell’osteoporosi menopausale.

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Authors and Affiliations

  1. Cattedra di Ginecologia Oncologica, Dipartimento di Discipline Ginecologiche e Ostetriche, Università di Torino, Via Ventimiglia, 3, 10126, Torino, Italia

    Piero Sismondi, Nicoletta Biglia, Ester Ujcic, Simona Ambroggio, Riccardo Ponzone, Riccardo Roagna, Luca Sgro & Furio Maggiorotto

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  1. Piero Sismondi
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  2. Nicoletta Biglia
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  3. Ester Ujcic
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  4. Simona Ambroggio
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  5. Riccardo Ponzone
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  7. Luca Sgro
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  8. Furio Maggiorotto
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Sismondi, P., Biglia, N., Ujcic, E. et al. Ruolo del raloxifene nella prevenzione e terapia dell’osteoporosi post-menopausale. L’Endocrinologo 2, 153–158 (2001). https://doi.org/10.1007/BF03344401

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