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Diabetes mellitus complicated with osteoporosis requires coordinated management of metabolic control, bone health, psychological status, and social support. This retrospective clinical study evaluated a symptom-psychology-society three-dimensional nursing intervention for patients with diabetes complicated by osteoporosis. A retrospective evaluation was conducted in 132 patients with diabetes complicated by osteoporosis. Patients were categorized according to the nursing pathway documented in medical and nursing records: routine nursing or a three-dimensional intervention. The intervention consisted of three sequential components. First, symptom management included individualized glucose monitoring, medication-adherence support, dietary and exercise guidance, calcium and vitamin D supplementation guidance, and osteoporosis-related follow-up. Second, psychological support included SAS/SDS-based screening, monthly counseling for patients exceeding predefined thresholds, routine emotional support for patients below the thresholds, and referral when persistent severe symptoms were identified. Third, social support included family education, community-health linkage, monthly home visits, and adherence documentation. Outcomes were assessed at baseline, 6 months, and 12 months, including BMD, FRAX scores, metabolic indicators, SAS, SDS, SSRS, and fracture occurrence. The intervention group showed more favorable changes in BMD, FRAX scores, metabolic indicators, psychological scores, social support, and total 12-month fracture incidence than the routine nursing group. These findings provide preliminary clinical evidence for a structured and reproducible nursing pathway for integrated management of diabetes complicated by osteoporosis.