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Diabetes and Vascular Disease

SUN-547 - Temporal Trends and Disparities in Fracture-Related Deaths in Patients with Diabetes Mellitus: A Nationwide Study

Sunday, June 14, 2026
9:00 AM - 4:00 PM CT
Disclosure(s):
Abedel Hamdan, MD/MHA Candidate: No financial relationships to disclose


Background:
Diabetes mellitus (DM) has been identified as a risk factor for fractures, with proposed mechanisms including advanced glycation end-products accumulation in the bone matrix and impaired turnover. However, national patterns of fracture-related deaths among individuals with DM are not well described. This study evaluates temporal trends and demographic disparities in fracture-related mortality in DM patients in the United States.

Methods:
We conducted an observational study using CDC WONDER multiple cause-of-death data from 1999-2019. Crude and age-adjusted mortality rates (AAMRs) per 100,000 population were calculated. Joinpoint regression was used to estimate annual percent change (APC) and average APC (AAPC). Analyses were stratified by age, sex, race/ethnicity, geographic region, and place of death.

Results:
A total of 56,196 fracture-related deaths among individuals with DM were identified between 1999-2019. The overall age-adjusted mortality rate increased from 0.67 in 1999 to 0.89 in 2019 (AAPC 1.43% (95% CI 1.07-1.87). Most deaths occurred in inpatient medical facilities (47.6%). Mortality disproportionately affected older adults, with individuals aged ≥85 years exhibiting the highest crude mortality rate (20.5/100000). Men experienced a greater rise in mortality compared to women (AAPC 2.06% versus 0.71%). By race/ethnicity, Non-Hispanic American Indians/Alaska Natives showed the highest burden (overall AAMR 1.64). Geographically, the South had the fastest increases (AAPC 2.04%). Rural areas had higher AAMRs than urban areas (1.04 versus 0.75). However, urban areas experienced a greater increase over time, with a higher AAPC (1.62% versus 0.85%). The highest age-adjusted rates were observed in the states Minnesota (AAMR 2.07) and Vermont (AAMR 2.02).

Conclusions:
Fracture-related mortality among diabetics has increased steadily in the United States from 1999-2019, with disparities seen across demographic and geographic groups. Higher mortality in rural areas, alongside faster increases in urban settings, and a disproportionate burden among older adults and Indigenous populations indicate the need for targeted, equity-focused prevention and management strategies.

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