Purpose of Review <p>This paper will discuss the impact of type 2 diabetes (T2D) on skeletal health in youth. We will review the myriad physiology and pathophysiology of diabetic bone fragility with a focus on several new findings in the past five years.</p> Recent Findings <p>T2D is associated with increased fracture risk despite normal or high bone mineral density. Evidence suggests T2D may adversely affect bone density acquisition during peak bone mass development. The pathophysiology involves low bone turnover, reduced unmineralized bone matrix, and increased collagen glycation, contributing to compromised bone strength. Recent findings from mouse models, Mendelian randomization, and human studies highlight the interplay between metabolic imbalances, genetic influences, cellular dysfunction, and treatment strategies.</p> Summary <p>Bone fragility is a frequently underdiagnosed complication in youth with T2D. Early intervention in youth is crucial to prevent the progression of metabolic and osteopathic disturbances associated with diabetes that can impact long-term skeletal health.</p>