Evolving Patterns in Hip Fracture Incidence and Osteoporosis Treatment in Japan: Insights and Implications

Japan’s national registry shows hip fracture counts rose through FY2017, plateaued for three years, then climbed again from FY2021 — a pattern temporally linked to declines in pre-fracture osteoporosis pharmacotherapy.

The registry analysis (FY2012–FY2023) reports age‑standardized trends that match this temporal pattern. This reversal in population-level risk follows a period of relative stabilization and coincides with pandemic-related interruptions to screening, routine visits, and medication continuity.

Linked claims and registry measures of osteoporosis treatment among adults ≥65 years show a decline in overall treatment prevalence from FY2020–FY2023, alongside greater use of denosumab, romosozumab, and eldecalcitol. The pattern suggests reduced broad bisphosphonate continuity with selective adoption of newer agents for higher-risk patients; the source provides absolute and relative change estimates for treatment prevalence.

These concurrent trends — fewer patients on continuous therapy and a shift toward targeted, high‑efficacy agents — are plausible contributors to the observed rise in hip fractures. Pandemic-era care delays, lower screening uptake, and medication nonadherence likely amplified population vulnerability. Modeling and temporal associations indicate that restoring pre-fracture medication rates and ensuring appropriate use of high-efficacy agents can lower hip fracture incidence.

For clinical practice, priorities are clear: recover screening programs for older adults, conduct focused medication reviews for patients with recent care gaps, and support adherence (reminders, outreach, and simplified regimens where appropriate). Match agent selection to fracture risk rather than defaulting to new drugs when continuity is interrupted.

Key Takeaways:

• Hip fracture incidence rose to FY2017, plateaued, and climbed again from FY2021.
• Osteoporosis treatment rates declined from FY2020–FY2023 while newer agents gained use.
• Restoring screening and adherence-focused care is the most actionable strategy to reduce fractures.