Background and aims: Novel evidence suggests that osteokines involved in bone metabolism influence neurocognitive impairment, further both cognitive impairment and bone fragility are recognized as novel complications of type 2 diabetes (T2D). In this study, we aimed to evaluate whether mild cognitive impairment (MCI) is associated with bone mineral density in people with T2D. Material and methods: A cross-sectional study was conducted, consecutively enrolling subjects with T2D, with disease duration <30 years, with HbA1c<10% and without diagnosis of any dementia. At baseline, clinical (age, disease duration, body mass index – BMI) and biochemical features (HbA1c, blood glucose, lipid, renal function) were collected. The Montreal Cognitive Assessment (MoCA) score was performed, MCI was defined as MoCA ≤25 points. Whole-body composition DEXA was performed to evaluate fat and lean mass and bone mineral density (BMD). Associations between risk factors and the outcome were tested by regression considering age and gender in all models and variables associated with MCI. Results: 136 subjects with T2D were enrolled (71% male, 69 [66-72] years old). Subjects with MCI showed lower weight (76.0[69.3-88.9] kg vs 83.0[76.0-91.0] kg, p=0.017) and longer disease duration (10[5-13] vs 8[4-11], p=0.044) and higher HbA1c (6.7[6.1-7.3]% vs 6.4[5.9-6.8]%, p=0.038) compared to subjects without MCI. Subjects with MCI were more frequently smokers (60% vs 40%, p=0.03). Subjects with MCI showed lower BMD at the hip (0.896[0.760-1.008] g/cm2 vs 0.988[0.892-1.079] g/cm2, p=0.002) and femoral neck (0.707[0.644-0.822] g/cm2 vs 0.790[0.720-0.860] g/cm2, p=0.011) compared to subjects with normal MoCA score. The association between MCI with BMD and smoking habit remains significant after multivariate correction (age, gender, weight, HbA1c and disease duration). Conclusion: In our population, MCI is associated with low BMD and therefore, with a likely increased risk of fractures. Further studies are needed to better understand the common mechanisms that are involved in cognitive and bone impairment.