ABSTRACT Background This study aimed to examine the management of bisphosphonate (BP) therapy for osteoporosis in Japan, focusing on treatment duration, dual‐energy X‐ray absorptiometry (DXA) assessment status, therapy despite renal impairment, and history of atypical femoral fracture (AFF). Methods This single‐center, cross‐sectional study included 117 women inpatients aged ≥ 65 years admitted to the Department of General Medicine at Nerima Hikarigaoka Hospital between October 2022 and September 2025 while receiving BP therapy. The primary outcome was the prevalence of ultra‐long‐term therapy (≥ 10 years oral or ≥ 6 years intravenous). Secondary outcomes included long‐term therapy (≥ 5 years oral or ≥ 3 years intravenous), unknown treatment duration, inadequate DXA assessment, therapy despite renal impairment (serum creatinine ≥ 1.5 mg/dL), and AFF history. Results The mean age was 84.3 ± 7.1 years. Ultra‐long‐term therapy occurred in 5.1% of patients, long‐term therapy in 23.1%, unknown treatment duration in 29.9%, and inadequate DXA assessment in 49.6%. Therapy despite renal impairment was noted in 6.8%, and one patient (0.8%) had AFF. Unknown treatment duration and inadequate DXA assessment were significantly more common in nonorthopedic care and in facility‐ or home‐based settings ( p < 0.01). Conclusions Among older women in Japan, ultra‐long‐term BP therapy was rare; however, nearly half lacked adequate assessment of treatment duration or documented DXA evaluation. These findings reveal shortcomings in long‐term osteoporosis management, particularly in nonorthopedic and facility‐ or home‐based care settings. Standardized reassessment, appropriate DXA evaluation, and improved information sharing across care transitions are essential to optimize treatment quality and safety in an aging population.
Harada et al. (Fri,) studied this question.