A 58-year-old postmenopausal woman has a DXA T-score of -2.5 at the lumbar spine. She had carcinoma of the breast treated 4 years ago and is currently disease free. Her mother sustained a hip fracture at age 70. She declines injections. Which agent is most appropriate?
- A Calcitriol
- B Teriparatide
- C Raloxifene ✓
- D Strontium ranelate
Correct answer: C. Raloxifene
Explanation
Raloxifene, a SERM, reduces vertebral fracture risk by about 30 percent and reduces the risk of ER positive breast cancer, making it attractive in a woman with prior breast carcinoma who refuses injectables. Teriparatide is contraindicated after skeletal radiation or with active malignancy risk concerns, and it is an injection. The key fact that kills strontium and calcitriol is that neither has demonstrated reduction of vertebral fracture risk comparable to raloxifene in this setting.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.