In patients with a history of retinal vein occlusion, how should the risk of recurrent thromboembolic events influence the selection of osteoporosis therapies?

The FDA-approved prescribing information for raloxifene explicitly lists retinal vein thrombosis alongside deep vein thrombosis and pulmonary embolism as contraindications.

The choice of therapy depends on the patient’s risk factor for fracture. I certainly would not use a SERM or estrogen in treating her, and I would try to avoid Romosozumab, but certainly a bisphosphonate or denosumab could be prescribed safely.