Background: Raloxifene is a selective estrogen receptor modulator (SERM) that binds to estrogen receptors with high affinity, acting as an estrogen agonist or antagonist in a tissue-specific manner. This study aimed to evaluate the effect of raloxifene on various cardiovascular risk determinants in postmenopausal women and to compare these effects with those in a control group. Methods: The study was conducted as a prospective, open, matched case-control study at Gazi University Hospital. A total of 100 postmenopausal women were included. Fifty postmenopausal women with osteoporosis received 60 mg of raloxifene daily. The other fifty healthy postmenopausal women in the control group received no treatment. After one year, changes in cardiovascular risk markers compared to baseline values were evaluated in both the treatment and control groups. The plasma determinants evaluated included total cholesterol, LDL, HDL, triglycerides, lipoprotein (a), Apo A, Apo B, homocysteine, hs-CRP, and fibrinogen. Carotid intima-media thickness, an important radiologic indicator of cardiovascular risk, was also measured and compared between the groups. Results: After the study, raloxifene was found to decrease levels of total cholesterol, LDL, homocysteine, and fibrinogen, but it did not affect HDL, triglyceride, Apo B, lipoprotein (a), and hs-CRP levels. There were no differences between the baseline values of the groups or the values of the control group after the study period. In the control group, there was a significant increase in carotid intima-media thickness compared to baseline values, while no such difference was observed in the raloxifene group. Conclusions: Raloxifene caused favorable changes in many biochemical and radiologic cardiovascular risk determinants compared to the control group. Further clinical studies are needed to determine whether these effects are associated with cardiovascular protection.

Background/Objectives: Menopausal hormone therapy (MHT) and alendronate improve bone mineral density (BMD), but their comparative effects on trabecular bone score (TBS) are unclear. We compared 12-month changes in TBS and site-specific BMD in postmenopausal women treated with MHT or alendronate. Methods: This retrospective cohort included 172 treatment-naïve postmenopausal women with newly diagnosed osteoporosis who initiated MHT (n=87) or alendronate 70 mg/week (n=85). Complete baseline and approximately 12-month DXA/TBS data were available for 164 women (MHT, n=83; alendronate, n=81). The primary outcome was the adjusted between-group difference in lumbar spine TBS at follow-up, assessed by analysis of covariance. Results: The adjusted MHT-minus-alendronate difference in TBS was 0.023 (95% CI, 0.010–0.036; P<0.001). TBS showed no significant within-group change with MHT (0.002 ± 0.044; P=0.699) but decreased with alendronate (−0.018 ± 0.040; P<0.001). BMD increased significantly in both groups, with greater gains with alendronate at the lumbar spine (adjusted difference, −0.014 g/cm²; 95% CI, −0.019 to −0.009; P<0.001), femoral neck (−0.005 g/cm²; 95% CI, −0.009 to −0.001; P=0.013), and total hip (−0.007 g/cm²; 95% CI, −0.011 to −0.003; P<0.001). Conclusions: Both treatments improved BMD, but alendronate produced larger gains, whereas no significant within-group change in TBS was observed with MHT. These findings suggest discordant treatment-related changes in BMD and TBS and warrant cautious interpretation because of the observational design and limitations of serial TBS monitoring.