BACKGROUND: Osteoporosis, a systemic skeletal disease characterized by low bone mass and increased fracture risk, poses significant social and economic challenges globally, while type 2 diabetes mellitus (T2DM), a prevalent metabolic disorder, has been linked to complex effects on bone health, including contradictory findings on its relationship with osteoporosis and fracture risk. METHODS: We searched PubMed, Embase, Cochrane, and Web of Science Library to identify observational studies investigating whether people with T2DM have a higher risk of osteoporosis or fracture than people without diabetes. The time limit for literature retrieval was from the establishment of the database until March 2023. The quality of the studies was assessed using the Newcastle-Ottawa Scale and Agency for Healthcare Research and Quality checklist. The meta-analysis was conducted using Stata 15, and a random-effects model was used if I2 was >
50%. The Egger test was used to assess publication bias. RESULTS: The results demonstrated that people with T2DM have a higher risk of osteoporosis. (relative risk, 1.841
95% confidence interval, 1.219-2.780
P = .004). Similar results were demonstrated for fractures (relative risk, 1.21
95% confidence interval, 1.09-1.31
P <
.001). However, the results of the subgroup analysis showed no significant correlation between T2DM and fractures in univariate analysis, cross-sectional studies, Asia, Europe, Oceania, and vertebral fractures. However, a significant correlation was found in other subgroup analyses. CONCLUSIONS: Osteoporosis and fractures are significantly associated with T2DM.