OBJECTIVE Diabetes is often associated with complications and comorbidities. Diabetic osteoporosis (OP) is increasingly recognized as a significant comorbidity of type 2 diabetes mellitus (T2-DM). In this study, we intended to determine whether type 2 diabetes was associated with a higher bone mineral density (BMD) in older males, and investigate the related risk factors of diabetes mellitus accompanied with OP. METHODS To assess the effects of diabetes and its complications on the risk of bone fractures, the daily glycemia, insulin and HbAlc of T2-DM patients were detected. At the same time, Dual Energy X-ray Absorptiometry (DEXA) was used to measure the BMD of whole body, lumbar spine and proximal femoral at 2-year intervals. RESULTS The BMD in elderly male patients suffered from T2-DM was associated with kidney function. The decrease of BMD in elderly male patients with T2-DM was related to HbA1c and body mass index (BMI). The BMD in group of renal function insufficiency or clinical albuminuria which are closely related with insulin insufficiency were much lower than that in the group of normal control. Additionally, a significantly lower (P<0.05) T-score was found in patients with nephropathy as compared with those without the complications. CONCLUSIONS The elderly patients with type 2 diabetes mellitus are prone to develop OP. The insufficiency of insulin, the decreased insulin sensitivity and diabetic nephropathy are important causes for OP in the patients with type 2 diabetes.