腎不全患者の骨病変に対するSERMsの有効性と安全性

Treatment of Bone Diseases in ESRD Patients. Efficacy and safety of selective estrogen receptor modulators in patients with advanced chronic kidney disease.

　SERMs（selective estrogen receptor modulators）は閉経後骨粗鬆症に対して椎体および大腿骨の骨密度を改善し，椎体骨折を減らす効果が期待される。透析患者を含む腎不全患者においても同様の効果が示されているものの，SERMsによる治療では大腿骨頸部骨折のリスク増大が残されてしまう。血栓症に対する注意が必要で，脳卒中のリスクにも留意する必要があるかもしれないという一方で，乳癌の発症および進展の抑制については他の薬剤にはない効果であり，酸化ストレス軽減などを介した腎保護作用も期待できるのかもしれない。

　Selective estrogen receptor modulators（SERMs）have beneficial effects on the improvement of bone mineral density of the spine and hip, and decrease the vertebral fracture in postmenopausal women. Similar to patients with advanced chronic kidney disease, including dialysis patients, however, SERMs cannot decrease the risk of hip fracture, which is extremely high in Japanese dialysis patients. One of the most important disadvantages of SERMs is an increase in the risk of venous thromboembolic events and fatal stroke in high-risk groups of the Framingham Stroke Risk Score. On the other hand, SERMs may be used in unique osteoporosis drugs for reducing the incidence and progression of breast cancer. Moreover, SERMs attenuate oxidative stress and may lessen the deterioration of kidney function in patients with chronic kidney disease. The evidences for the efficacy and safety of SERMs in patients with advanced chronic kidney disease are insufficient, and knowledge concerning the selection and indication of osteoporosis drugs for those patients need to be developed.