Introduction There are approximately 13 million patients with osteoporosis in Japan; however, only 20% of them receive treatment. This study compared the 4‐year continuation rates of osteoporosis drugs at different dosing intervals across throughout Japan. Materials and methods Receipt data were analyzed to determine the continuation of osteoporosis medication in patients who began treatment at 210 hospitals throughout Japan between October 2016 and September 2017. Continuation rates were compared using Kaplan–Meier curves and log‐rank tests. Results The 4‐year continuation rates of daily, weekly, monthly, semi‐annual, and yearly medications nationwide were 8.6%, 16.5%, 13.5%, 31.0%, and 26.0%, respectively. The 4‐year continuation rates for semi‐annual and yearly drugs were significantly higher than daily, weekly, monthly drugs. Conclusion Throughout Japan, the 4‐year treatment continuation rates of daily, weekly, monthly, semi‐annual, and yearly osteoporosis drugs all decreased over time. However, the continuation rates of semi‐annual and yearly drugs in the fourth year were significantly higher than those for the other dosing regimens. Therefore, injectable drugs with dosing intervals ≥6 months may improve continuation rates of osteoporosis drugs. Geriatr Gerontol Int 2023; 23: 665–670. In various regions of Japan, the 4‐year treatment continuation rates of daily, weekly, monthly, semi‐annual, and yearly drugs of osteoporosis drugs with different dosing intervals decreased over time. However, the continuation rates of semi‐annual and yearly drugs in the fourth year were significantly higher than those of the other drugs.