Objective To investigate the status quo of abnormal bone metabolism in elderly patients with type 2 diabetes mellitus (T2DM) in Xiangyang City, and to analyze its influencing factors. Methods Totally1 236 elderly patients with T2DM admitted to Xiangyang Central Hospital from January 2020 to January 2022 were selected as the study subjects. Questionnaires were distributed to calculate the incidence rate of osteoporosis (OP) and understand the status quo of osteoporosis in elderly T2DM population in Xiangyang City. The patients with OP were assigned as OP group(n=374), the patients with decreased bone mineral density were classified as the decreased bone mineral density group (n=266), and the patients with normal bone mineral density were set as control group(n=596). The influencing factors of OP in elderly T2DM population in Xiangyang City were explored. SPSS statistics 20.0 was used for data analysis. t test or Chi-square test was performed for comparison between groups according to the data types. Ordinal multivariate logistic regression analysis was used to analyze the related factors affecting the occurrence of abnormal bone metabolism in elderly patients with T2DM. Results Among 1 236 elderly patients with T2DM, 374 cases (30.26%) were diagnosed with OP. Ordinal multivariate logistic regression analysis showed that age≥80 years (OR=3.710,95%CI 1.588-8.668), female (OR=3.586,95%CI 1.831-7.024), T2DM course≥13 years (OR=2.563,95%CI 1.994-3.293), glycosylated hemoglobin A1c＞9.0% (OR=2.197,95%CI 1.137-4.244), and low-density lipoprotein cholesterol≥4.1 mol/L (OR=3.401,95%CI 1.362-8.494) were risk factors affecting bone metabolism status in elderly patients with T2DM, and body mass index≥24.0 kg/m² (OR=0.493,95%CI 0.318-0.765) and 25-hydroxy vitamin D3≥30 μg/L (OR=0.381,95%CI 0.235-0.617) were protective factors. Conclusion The detection rates of OP and bone mass loss in elderly patients with T2DM in Xiangyang City are similar to the national average level. Paying attention to bone mineral density examination in elderly patients with T2DM, actively controlling blood glucose, participating in physical exercise and strengthening vitamin D intake are of certain significance in improving abnormal bone metabolism in elderly patients with T2DM.