Background: Diabetes mellitus (DM) is a metabolic disease with an increasing prevalence worldwide. In Egypt, it affects a large sector of the population with a great financial and health burden. It was estimated that the number of diabetic patients in Egypt was 8.9 million people in 2020. DM affects nearly all body systems. Bone health is markedly affected by diabetes, and diabetes mellitus is associated with an increased fracture risk compared to non-diabetics individuals. Osteoporotic vertebral fractures are one of the most common osteoporotic fractures that are asymptomatic and may associate with diabetes. Aim of the work: This study aimed to investigate the prevalence of osteoporotic vertebral fractures among older adults type 2 diabetic females. Patients and Methods: A cross-sectional study was conducted on 100 older adults type 2 diabetic females aged ≥ 60 years, who were recruited from the inpatient wards and outpatient geriatric clinics of Mansoura University Hospitals. All participants were subjected to comprehensive geriatric assessments, BMI calculation (kg/m2), and assessment of 10 years probability of fractures risk using the WHO fracture risk assessment tool (FRAX). The Palestinian version of FRAX was used as the Egyptian version is not available yet. Plain x-ray on the dorsal and lumbar spines, both lateral and antero-posterior view, were done for assessment of vertebral fractures. Approval by the ethical committee of the Faculty of Medicine, Ain Shams University, has been taken. Results: The prevalence of osteoporotic vertebral fractures among older adults type 2 diabetic females was found to be 28%, Most of the fracture cases were asymptomatic. There was a significant association between vertebral osteoporotic fractures and history of cerebrovascular stroke, slower timed up and go test (TUG) times, a decline in instrumental activities of daily living (IADL), and increased fracture risk for major osteoporotic fractures in 10 years according to FRAX-Palestine. Conclusion: Prevalence of osteoporotic vertebral fractures among older adults type 2 diabetic females was found as high as 28%. There was a significant association between vertebral fractures and history of cerebrovascular stroke, slower TUG times, and functional decline in IADL, and increased fracture risk for major osteoporotic fractures in 10 years according to FRAX-Palestine.