Alteration of bone metabolism is a critical issue in T2 diabetes (T2DM) and is considered one of the new chronic complications of the disease. Diabetes mellitus is correlated with osteoporosis, that causes an increased risk of fracture, with muscle-related abnormalities up to diabetic sarcopenia. Chronic hyperglycemia represents the central point of the alterations that cause bone fragility, such as alterations in the immune, vascular, and muscoloskeletal systems. The co-occurrence of T2DM and osteoporosis is associated with fragility and poorer health outcomes, so it’s important that they are properly recognized and managed. New drugs, SGLT2 inhibitors and GLP1 RA, have clearly demonstrated important cardioprotective and nephroprotective effects in DMT2, and represent the gold standard of therapy for these patients. Due to the mechanism of action and pleiotropic effects of these drugs, it is essential to evaluate their effects on bone. The studies currently available seem to confirm their safety in terms of bone metabolism. However, it is more difficult to demonstrate a beneficial effect on bone because of the inconsistent results of the studies. More data are needed to verify this issue and draw definitive conclusions. The purpose of this chapter is to review the current literature on the topic.