OP patients with T2DM exhibited a more adverse metabolic-bone profile, including higher FGF23 and lower Apelin-13.<h4>Conclusion</h4>In this cross-sectional study, decreased BMD in postmenopausal T2DM women was independently associated with bone metabolism disorders, FGF23/Apelin-13 imbalance, and impaired nerve function. Here, APLN is linked to metabolic bone disorder.