In nondiabetic subjects, denser the bone, lower the risk of future fractures. In subjects with diabetes, even though the bones are dense on imaging, they are prone to fractures. The bone strength is low, despite greater density on imaging. Some antidiabetic medicines also have a propensity to lead to osteoporosis, but the following are safe in terms of bone health - metformin, sulfonylureas, DPP-4i, GLP-1 RA. Insulin should be used with care to avoid hypoglycemia.