Fragility fractures are a recognized complication of diabetes, increasing patient morbidity and mortality. Patients with type 1 diabetes have reduced bone mineral density, resulting in up to a sixfold increase in fracture risk. Conversely, in type 2 diabetes, fracture risk is increased despite normal or even higher bone mineral density. Thus, additional factors including alterations in bone material properties and bone microarchitecture could have important roles in mediating skeletal fragility in patients with type 2 diabetes. In this chapter, we highlight the latest advances in our understanding of the mechanisms of skeletal fragility in patients with diabetes and discuss potential novel therapeutic approaches that protect bone health in patients with diabetes.