Type 2 diabetes mellitus has recently been linked to an increased Since bone mass seems to be normal to elevated in patient with type 2 the increased fracture risk is thought to be due to both an increased frequency and decreased bone quality. The increased falling frequency is result of complications of the disease such as a retinopathy and Bone quality is affected through changes in bone shape, bone micro- and in material properties such as bone mineralization and the quality collagen. Commonly used methods for predicting fracture risk such as X-ray absorptiometry and fracture risk assessment tools are helpful in with type 2 diabetes mellitus, but underestimate the absolute fracture given score. New imaging modalities such as high resolution peripheral quantitative computed tomography are promising for giving insight in the etiology underlying the fragility of the diabetic bone, as they can give insight into the microarchitecture and geometry of the bone. We present overview of the contributing mechanisms to the increased fracture risk usefulness of imaging modalities and risk assessment tools in predicting risk in patients with type 2 diabetes.