Ask Dr. Stephan Moll

These questions have been submitted by folks on the mailing list and answered by Dr. Moll, Director of the Thrombophilia Program at the Carolina Cardiovascular Biology Center, Department of Medicine, Division of Hematology-Oncology, UNC Chapel Hill (North Carolina, USA). Why am I doing this?

60. Osteoporosis drugs and clotting

Q: "Has anyone taken Evista®? I heard that it can cause clotting but is good for the bones. I was on hormone replacement therapy when I got my first clot so that is out."

A: Yes, Evista can cause clotting and should, in most cases, not be taken by the woman with a history of blood clots.

Drugs that increase the risk of clotting:

* Any estrogen-containing preparations
* Evista (= raloxifene)

Drugs that do not increase the risk of clotting:

* Fosamax® (= alendronate)
* Actonel® (= risedronate)
* Didronel® (=etidronate)
* Calcimar&3174; or Miacalcin® (= calcitonin)
* Aredia® (= Pamidronate), given intravenously
* Zometa® (= Zoedronic acid), given intravenously

Phytoestrogens (isoflavones, soy concentrates, genistin, daidzein, etc.): Some data suggest that this product may slow osteoporosis and may be beneficial for hot flushes, but other studies have not shown a beneficial effect of these compounds. However, nothing is known whether they increase the risk of venous thromboembolism.

Reference:

• "Clinical Effects of Phytoestrogens". Clinical Obstetrics and Gynecology 2001;44:836-842

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