Epidemiology and disparities of mortality in comorbid cardiovascular disease and osteoporosis: A 25-year nationwide study in the United States

Abstract

Cardiovascular disease (CVD) and osteoporosis are highly prevalent age-related conditions that frequently coexist, yet their joint epidemiology and mortality burden remain poorly characterized in middle-aged and elderly adults. This retrospective cross-sectional study analyzed mortality data from the CDC WONDER database between 1999 and 2023. Cases were identified using ICD-10 codes for CVD (I00–I99) and osteoporosis (M80–M81). Age-adjusted mortality rates (AAMR) were calculated, and Joinpoint regression was applied to assess temporal trends across subgroups defined by age, sex, race/ethnicity, region, and urbanization. A total of 188,152 deaths were attributed to CVD with coexisting osteoporosis. The AAMR declined significantly from 9.28 per 100,000 in 1999 to 3.79 in 2023 (average annual percent change −3.73, p < 0.001). Women accounted for 88% of deaths, with consistently higher AAMR than men. Non-Hispanic Whites exhibited the highest mortality burden, while non-Hispanic Blacks had the lowest. Mortality increased markedly with age, particularly among those ≥85 years. Medium/small metropolitan and rural residents consistently demonstrated higher mortality rates compared with large metropolitan areas. Geographic variation persisted, with the Midwest and West showing the greatest burden. Mortality from comorbid CVD and osteoporosis has declined substantially over the past two decades in middle-aged and elderly adults, yet striking sex, racial, age, and geographic disparities persist. These findings underscore the need for integrated, tailored prevention and management strategies targeting high-risk populations.