Objective: To analyse the changes of bone metabolic markers in type 2 diabetes patients with osteoporosis, and analyze the risk factors. Methods: Eighty patients with type 2 diabetes and osteoporosis admitted to our hospital from January 2022 to December 2022 were selected as the research objects, and they were divided into osteoporosis group. Eighty patients with type 2 diabetes and non osteoporosis admitted to our hospital in the same period were selected as the non osteoporosis group, and 80 healthy volunteers who came to our hospital for physical examination in the same period were selected as the control group. The expression level of bone metabolic markers in three groups of subjects was compared, and dual energy X-ray absorptiometry was used as the "gold standard" for the diagnosis of osteoporosis. The ROC curve of subjects was established, and the critical value of related bone metabolic markers for the diagnosis of type 2 diabetes with osteoporosis was analyzed. Finally, the disease risk factors were analyzed. Results: There was no significant difference in the levels of alkaline phosphatase (ALP), blood phosphorus (P), and calcium (Ca) among the three groups of subjects (P>0.05). However, there were differences in the levels of urinary type 1 collagen C-terminal peptide (CTX-1), osteocalcin, and parathyroid hormone (PTH) among the three groups of subjects. There were also differences in the levels of CTX-1, osteocalcin, and parathyroid hormone (PTH) among the three groups of subjects PTH was higher than that of the non osteoporosis group and control group, while osteocalcin was lower than that of the non osteoporosis group and control group (P<0.05); The critical value of CTX-1 for the diagnosis of type 2 diabetes with osteoporosis was 525.74 μg/mmoL Cr, the sensitivity was 83.35%, the specificity was 67.95%, the critical value of osteocalcin was 14.12ng/L, the sensitivity was 81.27%, the specificity was 79.46%, and the critical value of PTH was 45.75 pmol/L, the sensitivity was 74.84%, the specificity was 81.36%; There was no difference between the osteoporosis group and the non osteoporosis group in terms of gender, duration of diabetes, combined with other basic diseases, peripheral neuropathy, and fasting blood glucose (P>0.05). There were differences between the osteoporosis group and the non osteoporosis group in terms of age, BMI, peripheral vascular disease, diabetes nephropathy, retinopathy, glycosylated hemoglobin, CTX-1, osteocalcin, and PTH levels (P<0.05); Age, diabetes nephropathy, retinopathy, glycosylated hemoglobin, CTX-1, osteocalcin, PTH were independent risk factors for type 2 diabetes with osteoporosis (P<0.05). Conclusion: The levels of CTX-1 and PTH in type 2 diabetes patients with osteoporosis increase and osteocalcin decreases. The three can provide important reference for the clinical diagnosis of type 2 diabetes patients with osteoporosis. Age, diabetes nephropathy, retinopathy, glycosylated hemoglobin, CTX-1, osteocalcin and PTH are independent risk factors for type 2 diabetes patients with osteoporosis. [ABSTRACT FROM AUTHOR]