Individuals with epilepsy have poor bone development and preservation throughout the lifespan and are vulnerable to nontrauma fracture (NTFx) and post-NTFx complications. However, no studies have examined the contribution of NTFx to mortality among adults with epilepsy. The objective was to determine whether NTFx is a risk factor for mortality among adults with epilepsy. Data from 2011 to 2016 were obtained from Optum Clinformatics Data Mart, a nationwide claims database from a single private payer in the United States. Diagnosis codes were used to identify adults (≥18years old) with epilepsy, NTFx, and covariates (demographics and pre-NTFx cardiovascular disease, respiratory disease, diabetes, chronic kidney disease, cancer). Crude mortality rate per 100 person-years was estimated. Cox regression estimated hazard ratios (HRs) and 95% confidence intervals (CIs) were determined for mortality, comparing epilepsy and NTFx (EP+NTFx; n=11471), epilepsy without NTFx (EP without NTFx; n=50384), without epilepsy and with NTFx (without EP+NTFx; n=423041), and without epilepsy and without NTFx (without EP without NTFx; n=6.8 million) after adjusting for covariates. The 3-, 6-, and 12-month crude mortality rates were highest among EP+NTFx (12-month mortality rate=8.79), followed by without EP+NTFx (12-month mortality rate=4.80), EP without NTFx (12-month mortality rate=3.06), and without EP without NTFx (12-month mortality rate=0.47). After adjustments, the mortality rate was elevated for EP+NTFx for all time points compared to EP without NTFx (eg, 12-month HR=1.70, 95% CI=1.58-1.85), without EP+NTFx (eg, 12-month HR=1.41, 95% CI=1.32-1.51), and without EP without NTFx (eg, 12-month HR=5.23, 95% CI=4.88-5.60). Stratified analyses showed higher adjusted HRs of 12-month mortality for EP+NTFx for all NTFx sites (ie, vertebral column, hip, extremities), all age categories (young, middle-aged, older), and for both women and men. Among adults with epilepsy and compared to adults without epilepsy, NTFx is associated with a higher 12-month mortality rate. Findings suggest that NTFx may be a robust risk factor for mortality among adults with epilepsy.