The aim of the present study was to identify the association of dietary patterns with osteoporosis in Korean postmenopausal women from the Korean Health and Nutrition Examination Survey 2008–10. The present cross-sectional analysis included 3735 postmenopausal women who completed a health interview, nutrition survey and a health examination including bone mineral density (BMD) measurements. The general characteristics and dietary intakes of the participants were obtained using a standardised questionnaire and a 24 h recall method, respectively. The BMD of the femoral neck and lumbar spine was measured using dual-energy X-ray absorptiometry; osteoporosis was defined based on the WHO T-score criteria. Overall, we identified four dietary patterns using factor analysis as follows: 'meat, alcohol and sugar', 'vegetables and soya sauce', 'white rice, kimchi and seaweed' and 'dairy and fruit', which accounted for 30·9% of the total variance in food intake (11·3, 7·7, 6·0 and 5·9%, respectively). The subjects in the highest quintile of the 'dairy and fruit' pattern showed a decreased risk of osteoporosis of the lumbar spine (53 %) compared with those in the lowest quintile, after adjusting for covariates (OR 0·47, 95% CI 0·35, 0·65, P for trend<0·0001). In contrast, the 'white rice, kimchi and seaweed' dietary pattern was negatively associated with bone health (OR 1·40, 95% CI 1·03, 1·90, P for trend=0·0479). The present results suggest that an increased intake of dairy foods and fruits in the traditional Korean diet, based on white rice and vegetables, may decrease the risk of osteoporosis in Korean postmenopausal women.