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Objective To investigate the correlation between bone mineral density ( BMD) and bone metabolic markers indexes and diabetic retinopathy (DR) in patients with type 2 diabetes mellitus ( T2DM), and to provide scientific evidence for bone health for T2DM patients. Methods Our study included 616 T2DM patients admitted to the Department of Endocrinology of Peking University Shenzhen Hospital from December 2018 to December 2019. Patients were divided into non-DR group ( 452 patients without DR) and DR group ( 164 patients with DR) to compare the gender, age, course of diabetes, BMI, smoking/drinking history, BMD, and bone metabolic markers indexes. Results Compared to those in non-DR group, the course of diabetes was higher, BMD values of T- and Z-score of the lumbar vertebrae L 1 -L4 , the femur, and the femoral neck were lower, the levels of bone metabolic markers (Ca, 24 h urine Ca, and 25 (OH) D3 ) were lower, and the levels of bone metabolic markers ( P and β-CTX) were higher in DR group. The prevalence of abnormal bone mass in T2DM patients with diabetic retinopathy was higher ( 59. 8% vs 50. 2%, OR= 1. 48; 95% Cl: 0. 99 - 2. 22). Conclusion When T2DM patients are complicated with DR, the expressions of bone formation markers and bone resorption markers increase, the rate of bone turnover accelerates, the level of PTH and the activity of osteoclasts increase, BMD decreases, and the prevalence of abnormal bone mass increases. [ABSTRACT FROM AUTHOR]