Objective To investigate the value of serum microRNA-187 (miR-187) and microRNA-210 (miR-210) levels in the diagnosis of osteoporosis in patients with type 2 diabetes mellitus (T2DM).Methods The 89 T2DM patients admitted to our hospital from June 2020 to September 2022 were selected as the study subjects. Serum miR-187 and miR-210 levels were detected in all patients, and bone mineral density was determined by dual-energy X-ray absorptiometry. Multivariable Logistic regression was used to analyze the factors affecting the development of osteoporosis in T2DM patients, and the value of miR-187 and miR-210 in the diagnosis of osteoporosis in T2DM patients was analyzed by the receiver operating characteristic (ROC) curve.Results There were statistically significant differences among the normal bone mass group, reduced bone mass group, and osteoporosis group in terms of T2DM duration, levels of fasting plasma glucose (FPG), fasting insulin (FINS), and 25-hydroxyvitamin D, and the relative expressions of miR-187 and miR-210, as determined by ANOVA (P < 0.05). Multivariable Logistic regression analysis showed that long disease duration of T2DM [O^R = 5.360 (95% CI: 2.206, 13.027) ], high levels of FPG [O^R = 4.495 (95% CI: 1.850, 10.925) ] and high relative expressions of miR-187 [O^R = 4.019 (95% CI: 1.654, 9.767) ] and miR-210 [O^R = 3.865 (95% CI: 1.590, 9.394) ] were risk factors for the development of osteoporosis in T2DM patients (P < 0.05). ROC curve analysis indicated that the sensitivities of miR-187, miR-210 and their combination for the diagnosis of osteoporosis in T2DM patients were 70.97% (95% CI: 51.76%, 85.11%), 74.19% (95% CI: 55.07%, 87.46%), and 80.65% (95% CI: 61.94%, 91.88%), with the specificities being 70.69% (95% CI: 57.09%, 81.54%), 77.59% (95% CI: 64.40%, 87.08%), and 91.38% (95% CI: 80.28%, 96.78%).Conclusions Serum miR-187 and miR-210 levels in T2DM patients are closely related to the development of osteoporosis, and miR-187 combined with miR-210 exhibits good efficacy in the diagnosis of osteoporosis in T2DM patients.