Which recommendation from the American College of Physicians is considered strong regarding osteoporosis treatment in postmenopausal women?

The recommendation to not use estrogen or raloxifene for the treatment of osteoporosis in postmenopausal women is based on a strong body of evidence indicating that the risks associated with these agents, particularly in terms of increased risk of thromboembolic events and breast cancer with estrogen or no significant benefits with raloxifene in certain population subgroups, outweigh the benefits for many patients.

Postmenopausal osteoporosis is a significant concern due to the increase in fracture risk associated with decreased estrogen levels. While estrogen therapy may provide some benefits in terms of bone density, the potential adverse effects have led to a re-evaluation of its use in osteoporosis treatment guidelines. Raloxifene, although a selective estrogen receptor modulator, has also been scrutinized for its impacts and does not have universal indications for treating bone density effectively in all women.

Overall, this recommendation reflects a commitment to safety and efficacy in osteoporosis management, leading to a stronger endorsement for alternative treatment strategies such as bisphosphonates, which have a better established risk-benefit profile for most postmenopausal women with osteoporosis.