Objective To explore the relationship between lipid metabolism and bone mineral density (BMD) in postmenopausal women with type 2 diabetes mellitus (T2DM) in Xinjiang. Methods A total of 136 postmenopausal women in Xinjiang were included and divided into four groups:normal glucose tolerance with normal bone mass group (control group, 26 cases), normal glucose tolerance with abnormal bone mass group (abnormal bone mass group, 28 cases), T2DM with normal bone mass group (T2DM group, 27 cases), and T2DM with abnormal bone mass group (55 cases). The age, height and other baseline data of each group were recorded. Blood calcium, blood phosphorus, alkaline phosphatase (ALP), triacylglycerol, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were measured by Roche automatic biochemical analyzer. The BMD of L₁-L₄, femoral neck and hip joint were measured by dual energy X-ray. Results The age and menopause years of T2DM with abnormal bone mass group were significantly higher than those of the control group (both Z=-2.54, both P<0.05). There were no significant difference in baseline indexes between abnormal bone mass group or T2DM group and control group (all P>0.05). The fasting blood glucose (Z=-4.08, -5.87, both P<0.01) and hemoglobin (Z=-4.59, -6.33, both P<0.01) levels in T2DM group and T2DM with abnormal bone mass group were higher than those in the control group; the lipid metabolism index triacylglycerol in T2DM with abnormal bone mass group was lower than that in the control group (Z=-2.01, P<0.05). The BMD of L₁-L₄ (Z=-6.23, -6.84, both P<0.01), femoral neck (Z=-5.32, -4.30, both P<0.01), and hip joint (Z=-5.44, -5.00, both P<0.01) in abnormal bone mass group and T2DM with abnormal bone mass group were lower than those in the control group. After adjusting the influence of age and menopause years, the results of partial correlation analysis showed that L₁-L₄, femoral neck and hip joint BMD were positively correlated with body mass index (r=0.209, 0.623, 0.265, P=0.015, 0.002, 0.002) and triacylglycerol (r=0.298, 0.233, 0.273, P<0.001, P=0.007, P=0.001), femoral neck and hip joint BMD were negatively correlated with HDL-C (r=-0.191, -0.200, P=0.027, 0.021) in 82 postmenopausal women with T2DM. Conclusion The elevated HDL-C and decreased triacylglycerol are associated with decreased BMD, which may promote the occurrence of osteoporosis in postmenopausal women with T2DM in Xinjiang.