Hunt HB, Miller NA, Hemmerling KJ, et al. - People with type 2 diabetes mellitus (T2DM) are at increased risk of fragility fracture, even after controlling for bone mineral density, body mass index, visual impairment, and falls. It is hypothesized that progressive glycemic derangement results in alteration of microscale bone tissue composition. Researchers studied the composition of iliac crest biopsies from cohorts of postmenopausal women characterized by oral glucose tolerance testing using Fourier‐transform infrared (FTIR) imaging: normal glucose tolerance (NGT; n = 35, age = 65 ± 7 years, HbA1c = 5.8 ± 0.3%), impaired glucose tolerance (IGT; n = 26, age = 64 ± 5 years, HbA1c = 6.0 ± 0.4%), and overt T2DM on insulin (n = 25, age = 64 ± 6 years, HbA1c = 9.13 ± 0.6). Outcomes revealed correlation of worsening glycemic control with greater mineral content and narrower distributions of acid phosphate, an indicator of new mineral, which together are consistent with observations of lower turnover; however, they also observed wider distributions of mineral crystallinity. A more mineralized, less heterogeneous tissue possibly affects tissue‐level mechanical properties, and in turn results in degradation macroscale skeletal integrity. These data are identified to yield the first evidence of progressive alteration of bone tissue composition with worsening glycemic control in humans.