Objective：To evaluate the effect of the PvuⅡ polymorphism（rs2234693，C>T）of the estrogen receptor alpha（ESR1）gene on fragility fractures in elderly postmenopausal women with heart failure（HF）. Methods：This was a hospital-based case-control study of postmenopausal women > 60 years of age with HF，including 80 fracture patients and 80 controls between January 2009 and January 2014. The PvuⅡ genotype was determined using a polymerase chain reaction-restriction fragment length polymorphism assay. Results：Fragility fracture was more common in smokers and those with a history of fragility fracture and less common in subjects who exercised daily. The PvuⅡ T allele was present in 83.75% of patients with fractures vs. 62.50% of controls. Carriers of the variant rs2234693T allele had increased risk of fracture（P < 0.05）. Compared with the common genotype，the CT+TT rs2234693 genotype was associated with significantly increased risk of fracture（P=0.036，adjusted odds ratio=1.323，95% confidence interval=1.263~2.787）. In stratified analyses，the association between the risk of fracture and the rs2234693 variant was more prominent in younger individuals（≤ 67 years）and non-smokers. Conclusion：The PvuⅡ polymorphism（rs2234693，C>T）of the ESR1 gene may contribute to the susceptibility of fragility fractures in elderly postmenopausal women with HF.