Due to the increasing mortality and disability rates associated with hip and vertebral fractures in older age, research is currently focusing on "new" determinants of osteoporosis in elderly subjects. Most recently, low bone mineral density (BMD) has been repeatedly reported in patients with end-stage heart failure. We assessed the association, if any, of BMD with left ventricular ejection fraction (LVEF) in a general older population. We assessed the association of LVEF with T score, Z score, and stiffness index in all 312 subjects aged 75 and over living in Tuscania, Italy. Among women, LVEF was associated with T score (beta = 0.02, 95% CI 0.01-0.05; P = 0.033), Z score (beta = 0.02, 95% CI 0.01-0.04; P = 0.038), and stiffness index (beta = 0.25, 95% CI 0.02-0.48; P = 0.036) in multivariable linear regression analysis, after adjusting for lifestyle habits, demographic variables, comorbid conditions, polypharmacy, and objective measurements. No significant associations were observed in men. In linear discriminant analysis, the LVEF cutoff level that best predicted osteoporosis was < or =49%. Left ventricular function is directly and independently associated with all of the ultrasonographic BMD parameters in older women. As left ventricular dysfunction, often asymptomatic, is a prevalent finding in older women, this association and its potential therapeutic implications should be assessed in dedicated studies.