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Raloxifene Lowers Serum Calcium and Markers of Bone Turnover in Postmenopausal Women with Primary Hyperparathyroidism

Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York 10032

Address all correspondence and requests for reprints to: Shonni J. Silverberg, M.D., Department of Medicine, Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, New York 10032. Tel: (212) 305-6238, Fax: (212) 305-6486, E-mail: sjs5{at}columbia edu.

Estrogen replacement therapy (ERT) decreases total serum calcium by about 0.5 mg/dl in postmenopausal women with primary hyperparathyroidism (PHPT). We investigated the ability of raloxifene, which has skeletal antiresorptive properties similar to those of ERT, to decrease serum calcium concentrations and markers of bone turnover in PHPT. Eighteen postmenopausal women with asymptomatic PHPT were randomized to 8 wk of raloxifene (60 mg/d) or placebo, followed by a 4-wk washout. At baseline, the groups were well matched. The calcium concentration decreased significantly by 8 wk of raloxifene administration (10.8 ± 0.2 to 10.4 ± 0.2 mg/dl; P < 0.05), as did markers of bone resorption and formation [osteocalcin, 11.4 ± 1.6 to 9.9 ± 1.6 nmol/liter (P < 0.05); serum N-telopeptide, 21.2 ± 3.4 to 17.3 ± 2.8 nmol bone collagen equivalents/liter (P < 0.05)]. Four weeks after raloxifene was discontinued, indices were indistinguishable from baseline. Raloxifene administration did not affect serum PTH, 1,25-dihydroxyvitamin D, total alkaline phosphatase, or urinary calcium excretion. Calcium and bone marker changes were therefore similar to those observed with ERT in PHPT. This short-term study suggests that raloxifene may be a useful approach to the treatment of postmenopausal women with mild PHPT.

This work was supported by an investigator-initiated grant from Eli Lilly \|[amp ]\| Co.

Abbreviations: BCE, Bone collagen equivalents; ERT, estrogen replacement therapy; NTX, N-telopeptide; PHPT, primary hyperparathyroidism; SERM, selective estrogen receptor modulator.

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