Background: The most frequent type of osteoporotic fractures is vertebral fractures (VFs), and identifying them is crucial for the diagnosis of osteoporosis as well as for future fracture risk assessment and treatment options Aim of the work: This study aimed to determine the utility of trabecular bone score (TBS) in post-menopausal type 2 diabetic patients with vertebral fractures (VFs) and the relationship of TBS with bone mineral density (BMD) and fracture risk assessment  (FRAX) score. Methods: This case-control study included a total number of 100 postmenopausal women patients from Endocrinology Clinics and Mansoura Specialized Hospital. They were divided into 4 groups: 25 postmenopausal women with T2DM and VFs, 25 postmenopausal women with T2DM without VFS, 25 postmenopausal women without T2DM with VFS and 25 postmenopausal women without T2DM without VFS.The study's period was from November 2020 to February 2022. Results: A statistically significant difference in all studied parameters between the 4 groups except body weight. In the two DM groups' age, menopausal length, HbA1c, FRAX-MOPF (percent), and FRAX-HF (percent) values were statistically greater than those of the two non-DM groups. Also, TBS T-score was statistically significantly lower in the DM/VF group vs. non-DM/non-VF group. BMD T-score was lesser in DM/VF group vs. the two non-DM groups, Conclusion: This study demonstrated that there are many factors contributing to the prevalence of vertebral fractures. These factors include duration of diabetes, poor diabetic control, BMI, drugs taken, BMD, and duration of menopause.