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Objective To investigate the associations among serum sodium, Geriatric Nutrition Risk Index (GNRI) and the risks of fragility fractures in patients with type 2 diabetes (T2D).Design A retrospective cohort study.Setting The restricted cubic spline model was used to analyse the relationships between exposures (serum sodium and GNRI) and the risks of fragility fractures. The independent and combined effects between exposures and fragility fractures were examined using the Cox proportional hazards model. Subgroup analysis and sensitivity analysis were used to further examine the relationships between exposures and fragility fractures.Participants 6221 participants diagnosed with T2D between January 2009 and March 2020 who were older than 45 years were included.Primary outcome measures Assessing the risks of fragility fractures in patients with T2D based on discharge diagnoses in the hospital discharge records.Results Serum sodium and fragility fractures had a U-shaped relationship, while GNRI and fragility fractures had a reverse S-shaped relationship. In the fully adjusted model 3, low sodium was significantly linked to around double the elevated risks of fragility fractures (HR, 1.87; 95% CI 1.23 to 2.83). Moderate (HR, 1.60; 95% CI 1.20 to 2.12) and low (HR, 2.28; 95% CI 1.40 to 3.71) GNRI levels were associated with increased risks of fragility fractures in the model 1. In the joint model 4, low sodium in conjunction with moderate (HR, 2.35; 95% CI 1.29 to 4.28) and low (HR, 3.62; 95% CI 1.50 to 8.71) GNRI levels significantly elevated the risks of fragility fractures. The associations between exposures and fragility fractures were more likely in individuals older than 60 years.Conclusions Low sodium and low GNRI levels were associated with increased risks of fragility fractures in patients with T2D. Clinicians should carefully monitor serum sodium levels and nutritional status, and consider early intervention to lower the incidence of fragility fractures in older patients with T2D.