Introduction: Diabetes mellitus (DM) is a pandemic and heterogeneous metabolic disorder with significant morbidity and mortality. In addition, osteoporosis (OP) is a silent disease that constitutes an enormous socioeconomic crisis, with a harmful impact on morbidity and mortality. Therefore, this systematic review focuses on the association between OP and type 1 diabetes mellitus (T1DM). Methods: Systematic reviews of full-length articles published in English from January 1950 to October 2010 were identified in PubMed and other available electronic databases at Universiti Sains Malaysia Library Database. The following keywords were used for the search: T1DM, insulin, OP, bone mass, and skeletal. Studies of more than 20 patients with T1DM were included. Results: Fifty studies were identified. In general, most of the studies showed unambiguous evidence for a decrease in bone mineral density in T1DM. Conclusions: Screening, identification and prevention of potential risk factors for OP in T1DM patients are crucial and important in terms of preserving a good quality of life in diabetic patients. Patient education about an adequate calcium and vitamin D intake and regular exercise are important for improving muscle strength and balance, and specific measures for preventing falls. Furthermore, adequate glycemic control and the prevention of diabetic complications are the starting point of therapy in T1DM. © 2012 The Japan Diabetes Society.