Purpose: To investigate the correlation of serum 25-hydroxy vitamin D [25(OH)D] with leptin (LEP) and visceral fat area (VFA) in type 2 diabetes mellitus (T2DM) patients with osteoporosis (OP). Methods: A total of 135 T2DM patients with newly diagnosed admitted to the Department of Endocrinology, Affiliated Hospital of Zunyi Medical College. The patients were divided into three groups according to BMD status: (1) DMNB group, n=45; (2) DMLB group, n=45; and (3) DMOP group, n=45. The control group consisted of 50 age and gender matched subjects recruited from the Physical Examination Center (NC group). All patients were examined for general biochemical indicators and QCT was used to measure VFA. Electrochemiluminescence (ECL) and enzyme linked immunosorbent assay (ELISA) were used to evaluate the serum levels of 25 (OH)D and LEP, respectively. Results: Compared with NC group, the levels of 25 (OH)D, L1-L4 lumbar vertebrae and left femoral neck BMD in DMNB group, DMLB group and DMOP group were significantly lower (P<0.05), the LEP and VFA levels were significantly increased (P<0.05). Conclusions: Our data showed a strong correlation between decreased 25 (OH)D and increased LEP serum levels in T2DM patients presenting with comorbid OP. This patient cohort also exhibited significantly higher VFA, which is symptomatic of imbalanced glucose and lipid metabolism.