Which preventive strategy against osteoporosis increases the incidence of hot flashes in perimenopausal females?

In the context of osteoporosis prevention, raloxifene is a selective estrogen receptor modulator (SERM) that mimics estrogen's beneficial effects on bone density while minimizing some of the adverse effects associated with estrogen therapy. However, one of the side effects of taking raloxifene is an increase in the incidence of hot flashes, particularly in perimenopausal women. This is due to its estrogenic activity in the bone and antagonistic effect on other tissues, such as the breast and endometrium, which can lead to hot flashes as estrogen levels fluctuate during the perimenopausal transition.

In contrast, calcitonin, alendronate, and estrogen/progesterone replacement therapy have different mechanisms and side effects associated with them that do not primarily include an increase in hot flashes. Estrogen therapy can mitigate hot flashes but does not increase them. Calcitonin is primarily used for pain relief in osteoporotic fractures and does not affect hot flashes, while alendronate acts as a bisphosphonate to inhibit bone resorption without influencing estrogen levels or hot flashes directly. Therefore, the association of increased hot flashes in perimenopausal females is specifically linked to raloxifene when considering preventive strategies against osteoporosis.