The Molecular Pharmacology of SERMs.

Estrogen-containing medicines have been used successfully for the past 50 years for the treatment of conditions associated with menopause. Although initially considered a reproductive hormone, millions of years of clinical exposure to estrogen(s) have indicated that its influence extends to a variety of target tissues not generally considered to be involved in reproduction. Specifically, estrogen has positive actions in the skeleton, the cardiovascular system and possibly the central nervous system, activities that combine to have a positive impact on mortality and morbidity. However, despite the medical benefits afforded by estrogen replacement therapy, the number of women who initiate or remain on therapy for longer than one year is relatively small. This is due in part to the fear that estrogens increase the risk for breast cancer. Consequently, it was realized several years ago that novel estrogen receptor modulators were needed, which would retain the beneficial effects of estrogens in most target organs but be inactive in the breast. Although the perfect tissue-selective estrogen remains to be identified, progress in this direction has been made. In the past year, for example, we have seen selective estrogen receptor modulators (SERMs) enter into the clinic for the prevention of osteoporosis. Compounds of this class, which function as estrogens in the skeletal system but oppose estrogen action in the breast, are the first step in developing the perfect hormone replacement therapy. This review summarizes the complex pharmacology of the SERMs and illustrates how they differ mechanistically from estradiol, the physiological ligand of the estrogen receptor.