{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T06:59:01Z","timestamp":1763621941534,"version":"3.44.0"},"reference-count":38,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T00:00:00Z","timestamp":1759104000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["Life"],"abstract":"<jats:p>Post-traumatic osteoarthritis (PTOA) is a distinct form of knee osteoarthritis characterized by accelerated joint degeneration following injury. It poses unique challenges in post-menopausal women due to hormonal changes and altered bone metabolism that create complex pathophysiological environments. This retrospective cohort study compared the effectiveness of different anti-osteoporotic medications in preventing total knee replacement (TKR) in 6155 postmenopausal women with PTOA treated between 2011 and 2021. We compared raloxifene and denosumab, with alendronate serving as the reference group. The primary outcome was TKR occurrence. Cox proportional hazards regression and inverse probability of treatment weighting (IPTW) were performed to estimate hazard ratios, with Kaplan\u2013Meier survival analysis for time-to-event assessment. Participants\u2019 mean (SD) age was 69.4 (10.0) years. Given the retrospective nature and typical delayed presentation of PTOA symptoms, cohort entry was defined as the concurrent diagnosis of PTOA and osteoporosis requiring anti-resorptive therapy. Over a mean follow-up of 5.47 years, 26 patients (0.42%) underwent TKR. Raloxifene was associated with a significantly reduced TKR risk compared to alendronate (IPTW-HR 0.81, 95% CI 0.67\u20130.99, p = 0.040), representing a 19% relative risk reduction. Kaplan\u2013Meier analysis demonstrated raloxifene maintained the lowest cumulative TKR incidence compared to alendronate and denosumab over time, particularly beyond 5 years. These findings suggest that raloxifene may offer superior joint protection compared with alendronate and denosumab in postmenopausal women with PTOA, supporting its potential as a disease-modifying therapeutic option for this vulnerable population.<\/jats:p>","DOI":"10.3390\/life15101531","type":"journal-article","created":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T10:49:34Z","timestamp":1759142974000},"page":"1531","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Raloxifene Is Associated with Total Knee Arthroplasty in Postmenopausal Women: A Comparative Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"given":"Jer-Yung","family":"Chen","sequence":"first","affiliation":[{"name":"School of Medicine, Tzu Chi University, Hualien 970374, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6945-712X","authenticated-orcid":false,"given":"Wen-Tien","family":"Wu","sequence":"additional","affiliation":[{"name":"School of Medicine, Tzu Chi University, Hualien 970374, Taiwan"},{"name":"Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan"},{"name":"Institute of Medical Sciences, Tzu Chi University, Hualien 970374, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6624-5893","authenticated-orcid":false,"given":"Ru-Ping","family":"Lee","sequence":"additional","affiliation":[{"name":"Institute of Medical Sciences, Tzu Chi University, Hualien 970374, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ting-Kuo","family":"Yao","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cheng-Huan","family":"Peng","sequence":"additional","affiliation":[{"name":"School of Medicine, Tzu Chi University, Hualien 970374, Taiwan"},{"name":"Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hao-Wen","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8005-9958","authenticated-orcid":false,"given":"Jen-Hung","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6154-2167","authenticated-orcid":false,"given":"Kuang-Ting","family":"Yeh","sequence":"additional","affiliation":[{"name":"School of Medicine, Tzu Chi University, Hualien 970374, Taiwan"},{"name":"Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan"},{"name":"Institute of Medical Sciences, Tzu Chi University, Hualien 970374, Taiwan"},{"name":"Graduate Institute of Clinical Pharmacy, Tzu Chi University, Hualien 970374, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/01.JAA.0000979536.73946.98","article-title":"Treatment options for symptomatic knee osteoarthritis in adults","volume":"36","author":"Clark","year":"2023","journal-title":"JAAPA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1007\/s12178-013-9164-0","article-title":"Knee osteoarthritis in women","volume":"6","author":"Hame","year":"2013","journal-title":"Curr. 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