Great that you brought this up!

I think raloxifene could potentially be a good option. However, its association with an increased risk of venous thromboembolism (VTE) is important to discuss with prescribers - especially for individuals with a history of VTE or other risk factors for blood clots. Another consideration is whether raloxifene is strong enough for patients with high baseline bone turnover, as indicated by elevated CTX levels, since it's a relatively weaker antiresorptive agent. That said, its action is easily reversible which makes it a useful option for bridging between two courses of anabolic therapy.

HRT is another agent with a reversible effect, but it's not considered a first-line treatment for osteoporosis. Additionally, there can be reluctance to prescribe it, particularly for older postmenopausal women.

Neither agent offers a substantial reduction in fracture risk (20-40%), which may limit their use in osteoporosis treatment, especially for individuals with a history of fractures. Using either agent as a bridge between two courses of anabolic therapy is an interesting approach worth discussing with a physician.