Raloxifene: Nursing Interventions and Monitoring

• Four main medication types prevent and treat osteoporosis: anti-resorptive, anabolic, calcitonin, and calcium supplements.
• Medications acting on estrogen receptors are also prescribed for postmenopausal clients.

Anti-Resorptive Agents

• These medications prevent and treat osteoporosis by decreasing bone resorption and preserving existing bone.
• Three main subcategories exist: selective estrogen receptor modulators (SERMs), bisphosphonates, and monoclonal antibody against RANKL.

SERMs (Selective Estrogen Receptor Modulators)

• SERMs are used primarily to prevent and treat postmenopausal osteoporosis.
• They are suitable for clients at risk for or previously treated for estrogen-dependent or receptor-positive cancer.
• Raloxifene is the prototype SERM medication.
• Raloxifene is prescribed more often than tamoxifen due to a lower risk of uterine cancer.
• SERMs activate estrogen receptors in some tissues and block them in others.
• This action decreases bone resorption and loss, maintaining bone mineral density (BMD).
• Raloxifene blocks estrogen receptors in breast tissue, which is beneficial for clients with estrogen-dependent or positive cancer.
• Raloxifene does not activate receptors in the endometrium.
• Adverse reactions primarily involve estrogen receptor activation.
• Serious adverse effects of raloxifene include increased risk of stroke, pulmonary embolism, and deep vein thrombosis.
• Clients may experience hot flashes due to estrogen receptor blockage.
• Pregnant or breastfeeding clients should not take SERMs because they are teratogenic.
• SERMs can pass through breast milk, exposing the infant.
• Monitor bone density to assess therapy effectiveness.
• Watch for signs of blood clots in the lower legs or lungs, such as leg cramps and difficulty breathing.
• Routine lab work is important due to potential fluctuations in cholesterol, hormones, and fibrinogen.
• Administer SERMs orally on a daily basis, with or without food.
• Clients should consume adequate calcium and vitamin D and perform daily weight-bearing exercises.
• Clients should use contraception during therapy due to teratogenic potential.
• Premenopausal clients using raloxifene for breast cancer prevention may experience hot flashes.
• Clients should immediately report lower extremity pain, especially in the calves, or chest pain with breathing difficulties.
• These symptoms may indicate a blood clot in the leg or lungs.
• Contraindications include pregnancy, breastfeeding, and a history of deep vein thrombosis.
• Clients who develop deep vein thrombosis during treatment should consult their provider about discontinuing the medication.
• Use SERMs cautiously in clients with elevated serum lipid levels.
• Concurrent administration with estrogen is not recommended due to the increased risk for estrogen-supported cancers.
• Raloxifene and tamoxifen both have teratogenic effects.