Diabetes alters bone mass and/or quality and increases fracture risk. However, in type 2 diabetes, bone mineral density (BMD) is usually not diminished, pertaining to increased weight and fat mass, which complicates the diagnosis of osteoporosis by DXA (T-score <-2.5). Similarly, estimates of fracture probability by FRAX may underestimate fracture risk in type 2 diabetes. Adequate glycemic control with insulin and/or oral antidiabetics decreases fracture risk, whereas thiazolidinediones increase it. Eventually, osteoporosis drugs such as bisphosphonates and SERMs seem to have similar efficacy in diabetic and non-diabetic patients.