Abstract: Objective To investigate the therapeutic gap and medication adherence in post-operative anti-osteoporotic treatment among patients with hip fractures, while identifying factors influencing adherence, with the objective of providing evidence-based recommendations for optimizing disease management strategies. Methods A cross-sectional study design was adopted, and a questionnaire survey was conducted on hip fracture patients who underwent surgical intervention for hip fractures at the Second Hospital of Baoding from January 2021 to June 2023. Descriptive statistical methods were utilized to analyze the magnitude of the therapeutic gap and adherence rates in anti-osteoporotic therapy post-hip fracture. Furthermore, univariate and multivariate logistic regression analyses were conducted to examine determinants impacting medication adherence. Results A total of 335 patients were included in the survey. Among them, 200 patients had not initiated anti-osteoporotic therapy within 12 months post-operatively, resulting in a therapeutic gap rate of 59.70% (200/335). Among the 135 patients who received anti-osteoporotic treatment, 56 patients (41.48%) demonstrated good adherence, whereas 79 patients (58.52%) exhibited poor adherence. Multivariate logistic regression analysis revealed that lower monthly per capita household income (<3 000 RMB or 3 000 - <5 000 RMB, OR=4.258, 3.554), type of medical insurance (residents' insurance or employees' insurance, OR=0.148, 0.214), living alone (OR=2.953), inadequate knowledge regarding osteoporosis (OR=2.616), absence of post-operative bone mineral density assessment (OR=5.340), and experiencing drug-related adverse reactions (OR=4.475) were all significant predictors of poor adherence to anti-osteoporotic therapy (all P<0.05). Conclusion sThere exists a substantial therapeutic gap in post-operative anti-osteoporotic treatment among patients with hip fractures. Additionally, adherence among those receiving treatment remains suboptimal. Tailored interventions should comprehensively address factors such as per capita household income, type of medical insurance, living situation, osteoporosis-related health literacy, post-operative bone mineral density monitoring, and drug-related adverse events in order to improve adherence and thereby facilitate better prognostic outcomes.

Key words: Hip fracture, Anti-osteoporotic therapy, Therapeutic gap, Medication adherence, Influencing factors