〔Abstract〕 Objective To investigate the correlation between the appendicular skeletal mass index(ASMI) and osteoporosis(OP) in postmenopausal patients with type 2 diabetes(T2DM). Methods 164 hospitalized postmenopausal elderly T2DM patients were selected and their bone density(BMD)and appendicular skeletal mass were measured using dual energy X-ray absorption method(DXA). ASMI=appendicular skeletal mass/height2(kg/m2), and they were divided into OP group and non OP group based on T value. The general clinical data, blood biochemical indicators, and ASMI between the two groups were compared, and Logistic regression analysis, ROC curve were further used to analyze the correlation and diagnostic power. Results Compared with non OP group, OP group had a higher incidence of sarcopenia(SAC)(P<0.05); the differences in age, ASMI, body mass index(BMI), and estradiol(E2) had significant differences between the two groups(P<0.05); Logistic regression analysis showed that the reduction of ASMI [OR=0.133,95%CI(0.029-0.611)], BMI[OR=0.785,95%CI(0.625-0.985)], and E2 [OR=0.967, 95%CI(0.942-0.993)] were protective factors for OP; receiver operating curve(ROC) suggested that the AUC of ASMI for OP prediction was 0.752 [95%CI(0.632-0.872),P<0.001] with sensitivity 87.5%,specificity 47.8%,and the best diagnostic value was 5.52 kg/m2. Conclusion The reduction of ASMI, BMI, and E2 is positively correlated with the occurrence of osteoporosis. ASMI is an important protective factor for osteoporosis. Early OP screening and risk factor assessment should be conducted for elderly postmenopausal T2DM patients, and early intervention measures should be taken to reduce the risk of falls and fractures.