This study aimed to clarify the changes in treatment regimens and medical expenditures in diabetic patients with osteoporosis. We recruited 2,853,036 diabetic patients from the Beijing medical insurance database between 2016 and 2018. Among them, 406,221 patients also had osteoporosis. Clinical characteristics, treatment regimens, and medical costs were investigated in diabetic patients with and without osteoporosis. Diabetes and osteoporosis were most prevalent in participants aged 45−84 years.