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Age, race, ethnicity, BP drug and route, prior fracture, and, in those aged\u2009\u2265\u200965\u00a0years, Veterans Affairs Frailty Index (VA-FI), were examined across five time periods. Temporal trends were analyzed using chi-square and nonparametric trend tests.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 298,340 men initiated a BP during 1999\u20132022, of whom 233,857 (78.4%) were aged\u2009\u2265\u200965\u00a0years. BP initiation rose sharply after FDA approval of BPs for men in 2000, peaked in 2004\u20132005, then declined by about 50% between 2006 and 2012, and then plateaued. Over time, the proportion of BP initiators aged\u2009&lt;\u200965\u00a0years declined from a peak of 28.2% during the middle time period (2008\u20132012) to a nadir of 13.3% during the final years (2018\u20132022,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001 for trend). Among the subset of men age 65 and older who initiated BP, the proportion with prior fracture increased from 8.3% in 1999\u20132002 to 24.5% in 2018\u20132022 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Notably, over half of the men who initiated BP during 1999\u20132002 were classified as non-frail, whereas in the most recent time period (2018\u20132022), over half of BP initiators were frail (mildly, moderately, or severely) and only 14.8% of them were non-frail (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In the VHA, BP initiating patterns shifted over time towards treating older men, with much larger proportions of men who had a prior fracture and were classified as frail.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11657-025-01635-z","type":"journal-article","created":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T08:25:36Z","timestamp":1767860736000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Shifting bisphosphonate prescribing patterns for fracture prevention: a 24-year national surveillance of men in the U.S. Veterans Health Administration"],"prefix":"10.1007","volume":"21","author":[{"given":"Rachel E.","family":"Elam","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan C.","family":"Lo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John T.","family":"Schousboe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert A.","family":"Adler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard A.","family":"Fink","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan M.","family":"Ott","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Barzilay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frances M.","family":"Weaver","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Budde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiping","family":"Huo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reside","family":"Jacob","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura D.","family":"Carbone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,8]]},"reference":[{"issue":"18","key":"1635_CR1","doi-asserted-by":"publisher","first-page":"1799","DOI":"10.1056\/NEJMoa074941","volume":"357","author":"KW Lyles","year":"2007","unstructured":"Lyles KW, Colon-Emeric CS, Magaziner JS et al (2007) Zoledronic acid and clinical fractures and mortality after hip fracture. 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