Abstract: Objective To investigate the relationship of type 2 diabetes mellitus (T2DM)-related factors with bone mineral density (BMD) and fracture risk in the elderly T2DM patients. Methods The clinical data of 307 elderly patients with T2DM were collected. The 10-year probability of a major osteoporotic fracture (PMOF) and the 10-year probability of a hip fracture(PHF) were estimated using Fracture Risk Assessment Tool (FRAX). The relationship of T2DM-related factors such as disease duration, the levels of insulin and C-peptide, medication usage with BMD and the risk of fracture were explored. Results With the increase of T2DM duration, BMD showed no significant change (P>0.05), while PMOF, PHF increased significantly (P_trend<0.05). The level of BMD at lumbar spine(L1, L3, L4)and femur neck(FN)in the patients receiving insulin-injection were higher than those in the patients receiving oral hypoglycemic agents. With the increase of the levels of insulin and C-peptide, the levels of BMD at L1-2 and FN showed a gradual increasing trend(P_trend<0.05), but there was no statistically significant difference in PMOF and PHF (P>0.05). In the linear regression, BMD at L1 was positively correlated with the level of insulin and insulin injection, and negatively correlated with neuropathy and hypoglycemia (P<0.05); PMOF and PHF had a positive correlation with hypoglycemia and diabetic vascular disease (P<0.05). Conclusions There is complex relationship of BMD and fracture risk with T2DM-related factors.BMD may increase with the usage of insulin, while fracture risk increases with disease duration, complication and hypoglycemia. Therefore, it is necessary to screen the high risk of fracture in the elderly patients with T2DM.

Key words: fracture risk, bone mineral density, type 2 diabetes mellitus, complication