BACKGROUND Adrenergic receptor α2A (α2A-AR) is up-regulated in osteoporotic bone osteoblasts. Previous research demonstrated an association between polymorphism of a2A-AR gene and bone mineral density (BMD) as well as bone turnover markers (BTMs) in the Slovenian population. The present study aimed to investigate the association of rs1800544 polymorphism of α2A-AR gene with BMD and BTMs in the Chinese elderly population with osteoporosis (OP) or with osteoporotic fractures. MATERIAL AND METHODS A total of 346 unrelated elderly individuals were recruited in the study. Rs1800544 polymorphism was determined by Snapshot technology. BTMs were determined by electrochemiluminescence. BMDs at lumbar spine (LS) and proximal femur were measured with dual-energy X-ray absorptiometry (DEXA). Hardy-Weinberg equilibrium and distribution of genotype frequencies were verified using the chi-squared test. Analysis of co-variance (ANCOVA) adjusted for confounding factors was performed to explore the relationship of rs1800544 polymorphism with BMD and BTMs in all participants and in subgroups. RESULTS The genotype distributions in all subjects and in subgroups conformed to Hardy-Weinberg equilibrium (P>0.1). Distribution of genotype frequencies of subgroups showed no significant differences (P>0.05). Patients with GG genotype in the fracture group had significantly higher serum BTMs level compared with those carrying other genotypes (P0.05). CONCLUSIONS Rs1800544 polymorphism is associated with BTMs level in Chinese elderly individuals with osteoporotic fractures, indicating the involvement of genetic variation of a2A-AR gene in bone metabolism.