Diabetes mellitus, which is a well-known chronic metabolic disorder with diverse complications, affects over 10% and up to nearly 20% of older adults; its prevalence is increasing rapidly. Fracture is also important issue in a large proportion of older adults and osteoporosis is a common cause of fracture. Therefore, both diabetes and increased fracture risks due to osteoporosis have become serious concerns and health problems in aging societies these days. However, the mechanisms of and exact relationship between diabetes and bone conditions are not fully understood and remain controversial issues because observational and animal studies do not show consistent results. Nonetheless, we should not overlook that bone quality and fractures are also important in older diabetic patients just as in the non-diabetic general population. Therefore, we need a better understanding of how diabetes and its treatment relate to bone health; this will improve morbidity and mortality in older diabetic and osteoporosis patients. Until these questions are answered, we should continue treating diabetic patients for osteoporosis with well-known current medications to improve bone mineral density besides including optimal glucose control and management of micro and macro vascular complications.