Background: Diabetes mellitus (DM) related bone fragility is characterized by a diagnostic paradox: despite the increased risk of fracture, patients with type 2 DM often show a normal/increased Bone Mineral Density (BMD) assessed by dual energy X-ray absorptiometry (DXA), with a compromised bone microarchitecture evaluated by Trabecular Bone Score Software (TBS). Deteriorated TBS represents a risk factor for developing fragility fractures independently of BMD levels, and a negative association with DM was found. Many studies have described the existence of relevant differences in bone’s characteristics between patients with DM and healthy controls. The purpose of the study is to determinate prevalence and bone characteristics of patients with DM in a selected population affected by fragility fractures and to search differences in bone features. Methods: Medical records of 589 patients belonging to CTO Bone Unit because of osteoporosis and fragility fractures were consulted. Patients were divided into two groups, according to the diagnosis of DM. The clinical and bone characteristics of patients were compared. Results: Prevalence of DM was 12.7%. When compared to patients without DM, the median age at the time of first fracture was similar (72 years±13.5 IQR vs 71 years±12 IQR); prevalence of combination of vertebral and hip fractures was higher (p=0.008), as well as prevalence of males (p=0.016). Bone mineral density (BMD) at all sites was significantly higher in DM group; Trabecular Bone Score (TBS) was significantly lower (p<0.001). Conclusions: Patients with fragility fractures and DM more frequently show combination of major fractures with higher BMD levels. In these patients, TBS could be a better indicator of bone health than BMD and therefore might be used as a diagnostic tool in clinical practice.