OBJECTIVES: In Germany, not only academic and non-academic hospitals but also office-based practitioners play an important role in providing care to cancer patients. Bone metastases (BM) are a late-stage complication of several cancer types for which the current gold standard treatment are bisphosphonates. Aim of this study was to investigate the initiation of cancer related bisphosphonate therapy depending on the type of treatment facility. METHODS:  This retrospective cohort study is based on a purchasable oncology database (IMS®Oncology Analyzer). This database provides comprehensive insight into cancer patient care with backdata until 1999. The analysed time period was January 2003 to December 2011. Main outcome measure was the initiation of bisphosphonate therapy depending on the type of treatment facility. A multivariate logistic regression model was fitted with the bisphosphonate therapy as dependent variable and indicator variables for office-based practitioners, general hospital and academic hospital. Demographic and clinical data were also analysed and included as confounders. RESULTS: Patients with BM following breast cancer (BC) (n=1957, mean age: 63.9 years), prostate cancer (PC) (n=1425, mean age: 70.8), non-small-cell-lung cancer (NSCLC) (1,543 patients, mean age: 63.6) or multiple myeloma (MM) (1,079 patients, mean age: 67.7) were selected. Of them 1338 (68.3%) of BC, 843 (59.2%) of PC, 795 (51.5%) of NSCLC and 912 (84.5%) of MM patients received treatment with bisphosphonates. MM patients have significant higher chances to receive bisphosphonate therapy in academic hospitals compared to office based practitioners (HR 1.64, p<0.01). In PC and BC, no differences between treatment facilities were found. For NSCLC patients the chance of bisphosphonate treatment was lower in academic hospital than at office-based practitioners (HR: 0.59, p=0.04).  CONCLUSIONS: Factors influencing the therapy initiation with bisphosphonates have to be identified in order to ensure optimal treatment of BM. Cancer type may play a role as shown in this study.