BACKGROUND: Recent studies suggest a possible pathogenic linkage between the osteoporosis and atherosclerosis. We investigated the relationship between cardiovascular risk factors, including high sensitivity C-reactive protein (hs-CRP), insulin resistance, lipid profiles and bone metabolism in Korean females. METHODS: Anthropometric measurements were performed on 437 women (mean age 52 yrs), and cardiovascular risk factors, including fasting blood glucose, fasting blood insulin, lipid profiles and hs-CRP, measured. An atherogenic index was calculated using the serum total cholesterol level divided by the high-density lipoprotein cholesterol (HDL-C) level. The lumbar spine bone mineral density (BMD) was measured using dual X-ray absorptiometry. RESULTS: From bivariate analyses, the lumbar spine BMD showed negative correlations with age, systolic and diastolic blood pressures, serum total cholesterol, low-density lipoprotein cholesterol (LDL-C), triglyceride levels and atherogenic index, and a positive correlation with the HDL-C level. After adjustment for age and BMI, the atherogenic index and HDL-C showed consistent correlation with the lumbar spine BMD. The log-transformed hs-CRP showed no correlation with the lumbar spine BMD. In premenopausal women, age, BMI and atherogenic index showed significant associations with the lumbar spine BMD and the atherogenic index showed consistently significant correlation, even after adjustment for age and BMI. In postmenopausal women, only age and BMI showed significant correlations with the lumbar spine BMD. From multiple linear regression analyses of all the study subjects, age, BMI, atherogenic index and the presence of menopause were found to be determinants of the lumbar spine BMD (R2 = 0.422, p < 0.05), which was consistently significant in analysis performed on premenopausal women (R2 = 0.157, P < 0.05). In postmenopausal women, age and BMI were found to be the determinants of the lumbar spine BMD (R2 = 0.257, P < 0.05). CONCLUSIONS: The lumbar spine BMD was negatively correlated with the atherogenic index in all and in premenopausal women. The menopause seems to play an important role in the relationship of cardiovascular risk factors with BMD in Korean females.