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Article History

Received: 27 February 2026

Accepted: 3 April 2026

First Online: 20 April 2026

Declarations

: Guarantor Masaki Hatano accepts full responsibility for the work and conduct of the study, has full access to the data, and controls the decision to publish it.

: This study was approved by the Institutional Review Board of the University of Tokyo [approval number: 2021010NI (23 April 2021)]. The requirement for informed consent was waived because all the data were de-identified.

: Not applicable.

: H. Yasunaga reports receiving an institutional grant from the Ministry of Health, Labor and Welfare, Japan (23AA2003). Tanaka has a collaborative research agreement with Amgen Inc. for a project involving the development and validation of hip and vertebral fractures using a claims database. T. Saito received lecture fees, outside the submitted work, from Kyowa Kirin Co., Ltd. S. Tanaka received lecture fees, outside the submitted work, from Asahi Kasei Pharma Corporation, Chugai Pharmaceutical Co., Ltd., Teijin Healthcare Limited, Amgen K.K., and Daiichi Sankyo Co., Ltd. Masaki Hatano, Yuya Kimura, and Hisatoshi Ishikura declare no conflicts of interest.

: The corresponding author attests that all listed authors meet the authorship criteria, and that no others meeting the criteria have been omitted.

: Large language models (LLMs) were used solely for spelling and grammar checks. LLMs were not used for data analysis, data interpretation, or drafting scientific conclusions.