Which is most appropriate for management of a woman diagnosed with postmenopausal osteoporosis with no history of fractures?

For a woman diagnosed with postmenopausal osteoporosis and without a history of fractures, the most appropriate management is the use of alendronate. Alendronate is a bisphosphonate that effectively reduces bone resorption and increases bone mineral density, which is crucial for preventing future fractures in individuals at risk for osteoporosis. It is particularly beneficial for postmenopausal women because it has been shown through multiple clinical studies to significantly reduce the incidence of vertebral and hip fractures.

Other options, while they may have their indications, are less optimal in this specific context. For instance, calcitonin is generally less effective than bisphosphonates and is typically utilized in those who cannot tolerate other treatments or in acute situations like fracture pain. Denosumab, while effective and used in cases of osteoporosis, is often reserved for patients who have already experienced fractures or for those who have not responded to other therapies. Raloxifene, a selective estrogen receptor modulator, provides benefits in terms of reducing the risk of vertebral fractures but does not have the same strength of evidence for reducing non-vertebral fractures as bisphosphonates like alendronate do.

Thus, alendronate stands out as the most appropriate