Background: Osteoporosis is a common and silent disorder with significant clinical consequences, particularly in postmenopausal women. Menopause increases the risk of osteoporosis, and metabolic diseases such as type 2 diabetes may further intensify this risk. Despite conflicting findings on osteoporosis prevalence among diabetic and non-diabetic postmenopausal women, no comprehensive study has been conducted in the population of Mashhad. This study aimed to determine the prevalence of osteoporosis and its associated risk factors in postmenopausal women with and without type 2 diabetes.

Methods: In this cross-sectional study, all postmenopausal women who visited the bone densitometry unit at Ghaem Hospital in Mashhad over one year were enrolled. Participants were divided into diabetic and non-diabetic groups. Demographic, clinical, and biochemical data were collected. Bone mineral density (BMD) was assessed at the femoral neck and lumbar spine. Data were analyzed using appropriate statistical tests.

Results: A total of 224 postmenopausal women (132 with diabetes, 92 without) were included. No significant differences were found in mean femoral T-scores or the prevalence of osteopenia/osteoporosis between groups. However, lumbar spine T-scores were significantly lower in non-diabetic women (–1.82 ± 1.01 vs. –1.50 ± 1.01; P = 0.019). Additionally, osteopenia/osteoporosis was more prevalent in the non-diabetic group (83.1% vs. 68.9%; P = 0.031). Other potential risk factors showed no significant differences.

Conclusion: Non-diabetic postmenopausal women had lower lumbar spine T-scores and a higher prevalence of osteoporosis compared to their diabetic counterparts. These findings may guide preventive strategies targeting this high-risk group.