Type 2 diabetes mellitus (T2DM) is a metabolic disorder characterized by hyperglycemia and insulin resistance, often leading to complications across multiple systems, including neuropathy, nephropathy, retinopathy, and bone diseases. Osteoporotic fractures are particularly concerning public health issues due to their high incidence, significant mortality rates, and substantial consumption of medical resources. Compared to non-diabetic individuals, patients with T2DM have an elevated risk of fragility fractures. Despite often having normal or increased bone density, the primary cause of this increased fracture risk is impaired bone quality. Understanding the pathogenesis of bone fragility associated with T2DM is crucial for improving screening and treatment strategies for patients at risk of fractures.The mechanisms underlying increased bone fragility in T2DM patients are complex and multifactorial, involving obesity, hyperglycemia, insulin resistance, oxidative stress, microvascular complications, and the accumulation of advanced glycation end products. These factors can lead to alterations in bone metabolism, structure, and strength. Additionally, other factors, such as hypoglycemia and the associated increased risk of falls, as well as the direct effects of certain antidiabetic medications on bone and mineral metabolism, may further contribute to the heightened fracture risk in this population. This review provides a concise overview of the mechanisms by which these factors influence bone fragility in patients with T2DM.