New bone-strengthening drugs safer than estrogen, one UA doctor says

Jennifer Holmes Arizona Daily Wildcat Dr. Michael Maricic lectures on osteoporosis treatments for post-menopausal women Saturday at UMC. As women's life expectancy rises, more will become susceptible to the disease, but one new drug is being used to combat it.

But University of Arizona researchers are testing new, synthetic drugs that may prevent the disease while reducing the risks associated with estrogen supplements.

Although estrogen has been used to maintain women's good health after menopause, it has some harmful side-effects, Dr. Michael Maricic said Saturday during a lecture group of about 100 at University Medical Center's DuVal Auditorium.

Therefore, doctors are studying drugs known as selective estrogen receptor modulators, which imitate estrogen's affect on bodily tissues.

"They have some of estrogen's good effects and most have none of estrogen's side-effects," said Maricic, director of the metabolic bone disease clinic at the UA College of Medicine.

During his lecture on the development of drug therapies for post-menopausal women, Maricic said studies have shown that woman can maintain bone density after menopause by taking estrogen supplements.

After menopause, the body stops producing estrogen in quantity and bone can lose density at a rate of up to 5 percent a year. Some older women suffer from osteoporosis - a disease in which bones become porous and fracture easily. About 4 percent of women die from an osteoporosis-induced hip fracture, Maricic said.

Raloxifene is the best estrogen replacement drug to hit the market yet, Maricic said. It became available about six months ago, but its effects are still being studied.

Like estrogen, Raloxifene prevents bone loss and fractures in post-menopausal women. Younger, pre-menopausal women and older women who have already suffered fractures also can take the medicine to avoid future bone loss.

The drug actually helps rebuild bone density at a rate of 1 percent to 2 percent a year.

Raloxifene, like estrogen, lowers cholesterol, but studies need to be conducted on more women to see if the drug is as effective as estrogen in impeding the advance of heart disease.

"Estrogen has a favorable effect on cholesterol and other lipids," by raising "good" cholesterol and lowering "bad" cholesterol, Maricic said.

Estrogen also dilates blood vessels, minimizing the risk of heart attack. Forty-five percent of women will die of cardiovascular disease - a problem related to menopause and lack of estrogen, Maricic said.

As women reach their 70s and 80s, "they get heart disease just as severely as men," Maricic said.

Studies are being conducted to see if Raloxifene prevents heart attacks as well as estrogen supplements do.

"That's really going to be the critical question because heart disease is the leading cause of death," Maricic said.

In addition to reducing risk of heart disease, studies show that taking estrogen supplements after menopause can prevent the onset of Alzheimer's disease. It is unknown if Raloxifene and other imitators can do this.

Despite its favorable effects, only one in three post-menopausal women take and stay on estrogen. Many women who refuse the hormone supplements fear harmful side-effects, Maricic said.

While estrogen promotes healthy hearts and minds, it also can contribute to higher risk of breast and uterine cancers. That's where medicines like Raloxifene come in. They are selective drugs that stimulate only the tissues a patient wants targeted.

For women taking estrogen, the chance of developing breast cancer goes from 6.2 percent to 6.8 percent. The risk is small, but for women with a family history of the disease, the increased danger is significant.

Estrogen supplements also cause an explosion of cell growth in the uterine lining in menopausal women. This growth can lead to bleeding or cancer of the uterus, Maricic said.

New drugs like Raloxifene may turn out to be life-savers for women who cannot or will not take estrogen because of its harmful side-effects. Studies show that Raloxifene actually inhibits the growth of breast cancer cells, and the drug does not encourage uterine cell growth in harmful ways.

Raloxifene has a few side-effects itself - including hot flashes and a slight increase in the risk of blood-clotting in the legs and lungs.

Development of estrogen replacements should skyrocket in the next few years, Maricic said. UMC researchers are conducting studies to compare some of the new drugs.

Post-menopausal women are about to become the largest sector of the population served by the health-care industry. Women live to an average age of 84, which means almost half of their lives are spent in a post-menopausal state.

Pharmaceutical companies will be scrambling to serve the growing population of older women, Maricic said.

Karen Liebler, a UA nurse coordinating one estrogen-replacement study, has been at UMC for 10 years.

"When I started (at UMC), there was nothing to treat osteoporosis," Liebler said. "Women just thought they would get old and get a hip fracture and get a hump on their back, and it doesn't have to be that way."

Many women in the audience were excited about a new-found chance to cure chronic diseases. Grace Taylor, a 64-year-old Tucson retiree, suffers from arthritis and osteoporosis.

"I wanted to become better informed and I certainly was," Taylor said about Maricic's lecture. "He just reinforced what my doctor told me, which is great - it's like getting a second opinion."

Despite the potential benefits of Raloxifene and other synthetics, Maricic pointed out that the drugs are new and researchers cannot be certain of their effects until they have been on the market for years.

"Most people still consider estrogen to be the drug of choice, mostly because estrogen has been out there for 35 or 40 years," Maricic said.

Sarah Spivack can be reached via e-mail at Sarah.Spivack@wildcat.arizona.edu.