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Longer duration of disease and poor glycaemic control are both associated with higher fracture risk. The factors underlying increased fracture risk have not been clearly established, but increased falls risk, obesity, sarcopenia and co\u2010morbidities are likely to contribute. The basis for reduced bone strength despite higher bone mineral density remains to be fully elucidated. Bone turnover is reduced in individuals with T2<jats:styled-content style=\"fixed-case\">DM<\/jats:styled-content>, with evidence of impaired bone formation. Most studies indicate normal or superior trabecular bone structure although reduced lumbar spine trabecular bone score (<jats:styled-content style=\"fixed-case\">TBS<\/jats:styled-content>) has been reported. Deficits in cortical bone structure have been demonstrated in some, but not all, studies whilst reduced bone material strength index (<jats:styled-content style=\"fixed-case\">BMS<\/jats:styled-content>i), as assessed by microindentation, has been a consistent finding. Accumulation of advanced glycation end products in bone may also contribute to reduced bone strength. The use of<jats:styled-content style=\"fixed-case\">FRAX<\/jats:styled-content>in individuals with T2<jats:styled-content style=\"fixed-case\">DM<\/jats:styled-content>underestimates fracture probability. Clinical management should focus on falls prevention strategies, avoidance of known risk factors, maintenance of good glycaemic control and bone protective intervention in individuals at high risk of fracture. Dietary and surgical strategies to reduce weight have beneficial effects on diabetes but may have adverse effects on skeletal health. Future research priorities include better definition of the mechanisms underlying increased fracture risk in T2<jats:styled-content style=\"fixed-case\">DM<\/jats:styled-content>and optimal strategies for identifying and treating those at high risk.<\/jats:p>","DOI":"10.1111\/joim.12725","type":"journal-article","created":{"date-parts":[[2017,12,19]],"date-time":"2017-12-19T17:46:44Z","timestamp":1513705604000},"page":"140-153","source":"Crossref","is-referenced-by-count":179,"title":["Type 2 diabetes mellitus and bone"],"prefix":"10.1111","volume":"283","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5660-4151","authenticated-orcid":false,"given":"J.","family":"Compston","sequence":"first","affiliation":[{"name":"Department of Medicine Cambridge Biomedical Campus Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,1,8]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"World Health 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