Although type 2 diabetes mellitus (T2DM) has been associated with an increase in fracture risk, there is no data regarding the prevalence of vertebral fractures or its risk factors for patients with T2DM in Korea. In this cross-sectional study, we recruited postmenopausal women with T2DM from 24 tertiary hospital diabetes clinics in Korea. Prevalent vertebral fractures were identified on lateral spinal radiographs of thoracolumbar vertebrae by vertebral morphometry. Demographic and biochemical characteristics related to diabetes were obtained, and bone mineral density of the lumbar spine and femoral neck, which was available in 752 (33.6 %) and 675 (30.1 %) patients, respectively, was also analyzed. Of the 2239 subjects recruited (mean age 63.9 years), a total of 970 (43.3 %) subjects had vertebral fractures. In the bivariate analysis, history of fragility fractures after 50 years of age, microalbuminuria, presence of cardiovascular disease (myocardial infarction, angina, cerebrovascular complications of cardiovascular disease), and presence of osteoporosis at the total hip were significantly associated with the presence of vertebral fractures, after adjusting for age. In the multivariate analysis, the presence of cardiovascular diseases in addition to advancing age and history of fragility fractures was significantly associated with increased odds of vertebral fractures. Vertebral fractures were highly prevalent in postmenopausal women with T2DM in this study conducted in Korea, and the presence of cardiovascular disease, in addition to older age and history of fragility fractures, was significantly associated with the presence of vertebral fractures.