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Objective: To explore the compliance in elderly male with osteoporosis treated with oral alendronate and analyze the factors which affect the therapeutic compliance., Methods: A total of 145 elderly male patients diagnosed with osteoporosis who had been initiated the treatment of oral alendronate in our clinic during January to June in 2011 were enrolled in the study. The medication compliance of one year was investigated. According to the different medication possession ratio (MPR), MPR ≥ 80% was considered as adherent and MPR < 80% was considered as non-adherent. The difference in the two groups was compared and the factors which affect the therapeutic compliance were analyzed., Result: A total of 139 patients had been followed up with 32 adherent cases (23.02%) and 107 non-adherent cases (76.98%). Logistic regression analysis showed the factors which affected the therapeutic compliance as the following: ostealgia (OR = 0.69, P = 0.043), no-reminder (OR = 1.37, P = 0.025), concern about drug related side effect (OR = 1.49, P = 0.018), more than 7 kinds of drugs (OR = 1.30, P = 0.036) and uncertain long-term effect (OR = 1.39, P = 0.021)., Conclusions: Compliance of oral alendronate to treat osteoporosis in elderly male patients is poor. Ostealgia can promote the drug compliance. The factors which could decrease the drug compliance are no-reminder, concern about drug related side effect, more than 7 kinds of drugs and uncertain long-term efficacy.