<p>Type 2 diabetes (T2D) increases the risk of hip fracture, yet its global burden remains poorly quantified. This study assessed the association between T2D and hip fracture and estimated the worldwide T2D-attributable burden from 1990 to 2021, with projections to 2046. We updated a meta-analysis of PubMed, Embase, and Cochrane databases to estimate the pooled risk ratio (RR) for hip fracture in adults aged ≥ 40 with T2D. Combining the pooled RR with T2D prevalence and hip fracture data from the Global Burden of Disease study, we calculated the T2D-attributable population attributable fraction (PAF) and burden. Age-standardized incidence rate (ASIR), years lived with disability rate (ASYR), and average annual percentage change (AAPC) were assessed. Eleven studies (from 11,358 screened) indicated that T2D increased hip fracture risk by 34% (RR 1.34, 95% CI 1.17–1.54). In 2021, 4.70% (2.36–7.34) of incident hip fractures (≈950,200 cases) were attributable to T2D, over four times the 1990 estimate (≈200,180 cases). From 1990 to 2021, ASIR and ASYR rose globally, with the highest rates in high socio-demographic index (SDI) regions, particularly High-income North America. Women and older adults had higher burdens, though increases were faster in men. Projections suggest continued global ASIR (AAPC 0.50%) and ASYR (AAPC 0.07%) growth through 2046. T2D significantly contributes to the global hip fracture burden, especially in high-SDI regions. The persistent sex and age disparities underscore the need for targeted prevention strategies in high-risk populations.</p>