• Fracture risk and fracture-related complications and costs are higher in type 2 diabetes mellitus and chronic kidney disease (CKD) patients.
• DXA T score does classify fracture risk in type 2 diabetes mellitus and CKD patients. More information is needed about novel imaging methods.
• PTH and bone turnover markers, particularly bone-specific alkaline phosphatase (BSAP), predict bone loss and can help guide treatment in CKD. Bone biopsies are only needed when turnover and/or osteomalacia cannot be determined noninvasively.

An individual and tailored approach to managing bone disease is critical in type 2 diabetes mellitus and CKD patients.