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.