Objective: To determine whether adherence to dietary patterns assessed by the alternative Mediterranean diet score (aMED), the Healthy Eating Index (HEI) 2010, the Alternate Healthy Eating Index (AHEI) 2010 or the Dietary Approach to Stop Hypertension (DASH) diet score is associated with hip or total fractures in postmenopausal women. Methods: The Women’s Health Initiative Observational Study (WHI-OS) prospectively followed 90,014 postmenopausal women. Food frequency questionnaires were used to assess adherence to established healthy eating patterns at baseline. Incident total and hip fractures were queried annually. We excluded toe, finger, sternum and clavicle fractures as total fracture events since these fractures are less likely related to osteoporosis. Associations of first incident fractures with dietary patterns were estimated using covariate-adjusted Cox proportional hazards models. Results: During a median follow-up of 15.9 years, we documented 2,121 hip fractures and 28,718 self-reported total fractures. In multivariable analyses, adhering to aMED was associated with a lower risk for hip fractures (HR Q5 = 0.80, 95% CI, 0.66, 0.97; p trend = 0.02) but not for total fractures (HR Q5 = 1.01, 95% CI, 0.95, 1.07; p trend = 0.77). Greater adherence to HEI-2010 or DASH was inversely related to hip fracture risk (p trend = 0.02 and 0.03, respectively) but not to total fracture risk (p trend = 0.15 and 0.47, respectively). The AHEI-2010 was not associated with total or hip fractures. Conclusions: Higher aMED, HEI-2010 or DASH dietary scoring was associated with lower risk for hip fractures. These results support that following a healthy dietary pattern is one cornerstone to maintain bone health in postmenopausal women. Table. Hazard Ratios (95% CI) for hip fractures and total fractures by quintiles of dietary pattern in the Women’s Health Initiative Observational Study 1 *Model 1 adjusted for age, race/ethnicity and body mass index. ** Model 2 model adjusted for age, race/ethnicity, body mass index, smoking status, physical activity, self-reported health, diabetes status, history of fracture at age ≥ 55, physical function score, number of chronic medical conditions, number of psychoactive medications and use of HT, bisphosphonates, calcitonin and SERM. 1 AHEI-2010, Alternative Healthy Eating Index[[Unable to Display Character: –]]2010; aMED, alternate Mediterranean Diet; DASH, Dietary Approaches to Stop Hypertension; HEI-2010, Healthy Eating Index[[Unable to Display Character: –]]2010; MCI, Mild Cognitive Impairment; PD, Probable Dementia. Quintile 1 (Q1) represents the least healthy quintile, whereas quintile 5 (Q5) represents the healthiest quintile.