Which class of medications, including raloxifene, reduces vertebral fracture risk in osteoporosis but carries risk of venous thromboembolism?

• A. Selective estrogen receptor modulators (SERMs)
• B. Bisphosphonates
• C. Calcitonin
• D. PTH analogs

Answer: (A)

The main idea is how osteoporosis medicines differ in both how they protect the bone and the risks they carry. The class that lowers vertebral fracture risk and is known to increase the risk of venous thromboembolism is the selective estrogen receptor modulators (SERMs). Raloxifene is one of these drugs. It acts like estrogen on bone, reducing bone resorption and improving bone density, which helps prevent vertebral fractures. But it acts like estrogen in ways that affect clotting, raising the chance of blood clots in the veins (deep vein thrombosis or pulmonary embolism). That combination—vertebral fracture protection with a higher VTE risk—is characteristic of SERMs.

Bisphosphonates also reduce vertebral fracture risk but don’t typically carry a notable VTE risk. Calcitonin has a more modest effect on vertebral fractures and a different side‑effect profile. PTH analogs stimulate new bone formation with a different risk spectrum and are not associated with increased VTE risk.