Abstract: Objective To evaluate the current status of anti-osteoporosis treatment among patients with fragility fractures and to explore its multidimensional influencing factors, thereby providing an evidence basis for the formulation of intervention strategies and the optimization of management pathways. Methods A cross-sectional survey was employed. A total of 412 patients with fragility fractures admitted to Beijing Luhe Hospital between June 2023 and June 2024 were included as study subjects. The receipt of anti-osteoporosis treatment was statistically recorded, and patients were subsequently categorized into a treatment group and a non-treatment group. The risk of refracture and the quality of life were assessed for both groups, and multivariate logistic regression analysis was conducted to identify the determinants of receiving anti-osteoporosis treatment. Results A final cohort of 396 patients was enrolled, of whom 138 (34.85%) received anti-osteoporosis therapy post-fracture. The multivariate logistic regression analysis indicated that age (OR=1.914), hip fracture (OR=2.122), bone mineral density (BMD) testing (OR=2.134), health beliefs (high necessity/high concern, OR=2.939; low necessity/high concern, OR=3.850), proportion of out-of-pocket payment (30%-60%, OR=3.905; >60%, OR=5.854), specialist referral (OR=2.193), clarity of discharge instructions (OR=2.527), disease cognition (OR=0.900), and fear of falling (OR=0.945) were significant factors influencing the initiation of anti-osteoporosis treatment following a fragility fracture (all P<0.05). Conclusions The rate of anti-osteoporosis treatment among patients with fragility fractures is suboptimal, constrained by a confluence of medical conditions (e.g., age, BMD testing), patient-related cognitive and belief factors (e.g., health perceptions, risk awareness), and healthcare policy elements (e.g., referral mechanisms, medical insurance coverage). It is recommended that clinical practice establishes an integrated management pathway encompassing screening, referral, and intervention. Furthermore, enhancing stratified patient education based on cognitive levels and optimizing medical insurance coverage to alleviate the economic burden are advised. A multidimensional, synergistic strategy is imperative to improve the standardization of treatment, consequently reducing the risk of subsequent fractures and improving the quality of life for this patient population.

Key words: Fragility fractures, Anti-osteoporotic treatment, Refracture risk, Bone mineral density testing, Health beliefs, Specialist referral