Kidney transplant recipients (KTRs) have an increased fracture risk, but clear guidelines for osteoporosis management, particularly beyond the first post-transplant year, are lacking. This study evaluates fracture incidence, bone mineral density (BMD) testing, and osteoporosis treatment patterns in KTRs. We analyzed 34,758 KTRs using national health insurance data. BMD testing, fracture history, osteoporosis medication use, and fracture incidence were assessed. Pre-transplant BMD testing was performed in 21.4%, and post-transplant testing in 63.8%, with only 46.9% occurring within the first year. Osteoporosis treatment within the first year was low (bisphosphonates 2.7%, SERMs 0.2%, denosumab 0.2%). Among prior osteoporosis medication users, 44.8% discontinued therapy. Overall fracture incidence was 10.6%, with higher rates in those with prior fractures (42.4% vs. 10.3%). Hip fractures occurred in 1.8%, and vertebral fractures in 3.0%. The median time to fracture was 5.4 years, with fractures occurring earlier in those with a prior history (206 days vs. 2065 days). Among those ≥65 years, 16.2% experienced fractures, compared to 14.8% in those aged 50-64 years and 7.9% in those <50 years. Despite high fracture risk, osteoporosis screening and treatment in KTRs remain inadequate, particularly beyond the first year post-transplant. Fractures, especially hip and vertebral fractures, often occur years later. Standardized, long-term management strategies are essential to mitigate fracture risk and improve bone health in KTRs.