In the U.S., osteoarthritis (OA) is a common contributor to disabilities, accompanied by a heightened risk of mortality. The primary aim of the study is to update the OA-related mortality patterns in the U.S. We leveraged data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database from 1999 to 2023 to evaluate age-adjusted mortality rates (AAMRs) of OA among adults aged ≥65 years in the U.S. Among the 16,011 OA-related deaths, the overall AAMR fell markedly from 2.40 (95% confidence interval (CI): [2.24, 2.57]) in 1999 to 0.59 (95% CI: [0.52, 0.66]) in 2023. Nevertheless, higher AAMRs were observed in older women, particularly those aged ≥85 years, non-Hispanic White individuals, and residents of the Midwest. For the past 25 years, disproportionate high mortality burdens have still existed among specific individuals despite a continuous decline in AAMRs.