MON-796 Factors Underlying Racial And Ethnic Disparities After Hip Fracture In Older Adults With Type 2 Diabetes

Abstract Disclosure: K.M. Okazaki: NIH grant funding (T32DK007028). S.M. Burnett-Bowie: None. L.A. Marion: None. S.J. Cromer: Spouse employed by Depuy-Synthes. J. Ortega-Montiel: None. C.F. Alix: None. E. Patorno: None. J.M. Paik: None. E.W. Yu: Amgen Inc. grant- unrelated to the topic of this work, Opko - Stock Shareholder, Wolters Kluwer - royalties. Purpose: Both racial and ethnic (R&E) disparities and T2D contribute to adverse outcomes after hip fracture. Mortality after hip fracture varies by race and ethnicity, with Black individuals having higher mortality than White individuals, as we and others have previously reported. Here, we aim to evaluate factors underlying R&E differences in mortality and to compare post-fracture care across race and ethnicity in a cohort of older adults with T2D. Methods: Using 2014-2020 Medicare data, we identified adults >65 yrs with T2D who sustained hip fractures. We assessed rates of mortality, bone mineral density (BMD) testing, osteoporosis treatment, and incident destitution rates across R&E groups within one year of hip fracture using Cox regression models adjusted for age, sex, and comorbidities. To identify potential mediators, subgroup analyses were performed and disparities were examined within strata of sex, age, geographic location, socioeconomic status (SES), BMI, and comorbidities including frailty and advanced chronic kidney disease (CKD stages 4-5). Results: Among 159,699 adults with T2D and hip fracture (mean age 82±8 yrs, 71% female), 87% were non-Hispanic White (NHW), 6% non-Hispanic Black (NHB), 3% Hispanic, and 2% non-Hispanic Asian (NHA). Overall mortality was 30.4% in the year after hip fracture. NHB individuals had higher 1-yr mortality (HR 1.26 [1.22-1.31]) as compared to NHW individuals, whereas NHA and Hispanic patients had lower mortality (HR 0.78 [0.73-0.83] and 0.91 [0.86-0.96], respectively). In stratified analyses, post-hip fracture mortality remained higher in NHB individuals compared to NHW within subgroups of sex, age, geographic location, BMI, and frailty; in contrast, racial disparities in mortality were not evident within those with low baseline SES (HR 1.0 [0.88-1.14]) or advanced CKD (HR 1.01 [0.93-1.09]). Overall rates of post-fracture BMD testing, osteoporosis treatment initiation, and incident destitution were low at 7.3%, 5.6%, and 5.7%, respectively. Compared to NHW individuals, NHB individuals had lower rates of BMD testing (HR 0.51 [0.45-0.56]) and osteoporosis treatment (HR 0.58 [0.51-0.65]), and higher rates of incident destitution (HR 1.41 [1.29-1.55]). Hispanic patients had 17% lower rates of bone density testing, but 18% higher rates of osteoporosis treatment compared to NHW individuals. NHA individuals had 53% higher osteoporosis treatment rates and 57% lower destitution rates compared to NHW individuals. Conclusion: Significant R&E disparities exist in post-hip fracture treatment and outcomes among older patients with T2D. Baseline differences in SES and advanced CKD may mediate increased post-fracture mortality in the NHB population. Further research is needed to address R&E disparities and to improve post-fracture care. Presentation: Monday, July 14, 2025