ObjectiveTo investigate the relationship among bone density, osteoprotegerin (OPG) and vascular calcification (VC) in maintenance hemodialysis (MHD) patients. MethodsOne hundred MHD patients were collected from our department between May 2010 and December 2012. The VC was detected by plain radiographs. Bone mineral density was measured with dual-energy X-ray absorptionmeter. The level of serum OPG was measured by enzymelinked immunosorbent assay. Other clinically related indicators were also detected. The related parameters were examined statistically. ResultsThe incidence of VC in MHD patients was 74% (74/100), and the OPG level significantly increased with the degree of vascular calcification (P<0.05). The proportion of patients with normal bone volume was 40%, and with abnormal bone volume was 60%. Compared with patients with normal bone volume, the patients with abnormal bone volume had higher serum OPG level (P<0.05). The patients with no VC had a lower incidence of abnormal bone volume than patients with VC (P<0.05). Multiple linear regression analysis revealed that vascular calcification score, OPG level and age were independent factors for bone mineral density. Dialysis time, OPG level, serum albumin level and bone mineral density were independent factors for vascular calcification score. ConclusionThe MHD patients with vascular calcification are often associated with osteoporosis at the same time. OPG plays an important role in the relationship between vascular calcification and osteoporosis.