Raloxifene for osteoporosis has which of the following risk/benefit profiles?

• A. Increases vertebral fractures.
• B. Stimulates osteoblasts.
• C. Reduces vertebral fractures; lowers risk of estrogen receptor-positive breast cancer; increases risk of venous thromboembolism and hot flashes; not for history of VTE.
• D. Approved only for men.

Answer: (C)

Raloxifene is a selective estrogen receptor modulator that acts on bone to help reduce vertebral fracture risk while also acting as an antagonist in breast tissue, lowering the risk of estrogen receptor–positive breast cancer. At the same time, it can raise the risk of venous thromboembolism and cause hot flashes. Because of the VTE risk, it is not used in people with a history of VTE, and it’s approved for postmenopausal osteoporosis in women rather than men. This combination of benefits and risks fits the profile described: reduction in vertebral fractures, reduced ER-positive breast cancer risk, and increased risk of VTE and hot flashes, with contraindication in those with a history of VTE.