Objectives The purpose of this study was to investigate the relationship between osteoporosis and cardiovascular risk factors according to Sasang constitution. Methods A total of 1773 participants, over 40 years old, were examined as part of a community-based cohort in Wonju city in Gangwon province of South Korea, from June 2006 to August 2009. We measured bone mineral density by Achilles ultrasonometer, serum levels of lipids, fasting blood sugar, insulin and other cardiovascular risk factors like blood pressure and waist circumference. Constitution was verified by a Sasang constitution specialist using the results of PSSC(Phonetic System for Sasang Constitution), facial photos and a simplified Sasang constitutional questionnaire. Results The prevalence rate was 11.2% in total participants, and 10.6% in Soyangin, 10.4% in Taeeumin and 13.9% in Soeumin. In general characteristics, educational and economic property and exercise were concerned with osteoporosis. Systolic blood pressure, pulse rate and total cholesterol were significantly high in osteoporosis group. Age and menopause were the key risk factors for osteoporosis. There was a significantly high prevalence in Soeumin for osteoporosis in men alone. Low physical activity was a major risk factor for osteoporosis. Waist circumference and hip circumference had significantly high odds ratio and weight had significantly low odds ratio. By Sasang constitution, Soyangin has the negative correlation with free fatty acid, Taeeumin has the negative correlation with waist circumference, pulse rate, systolic blood pressure, total cholesterol and low density lipoprotein and Soeumin has the positive correlation with body fat amount. Conclusions Regimens on osteoporosis should be considered according to Sasang constitution. Cardiovascular diseases should be considered according to Sasang constitution. Soeumin should be cautious of osteoporosis and gain weights and reasonable amount of fat food. Soyangin had better do exercise lower body and eat little food containing triglyceride. Taeeumin had better lose weights and eat little cholesterol food.