Objective    To explore the relationship between serum sclerostin level, and mineral metabolism, bone density, abdominal aortic calcification in maintenance hemodialysis (MHD) patients.    Methods    Serum sclerostin levels from 175 cases of MHD patients were measured by ELISA. Calcaneus bone mineral density (BMD) was measured by quantitative ultrasound (QUS). The abdominal aortic calcification was detected by abdomen lateral plain radiographs. Interrelations among above parameters were examined statistically.    Results    The median sclerostin concentration of 175 patients was 160.50(100.67, 256.39) pmol/L. Serum sclerostin levels were correlated positively with age, BMI, serum calcium and serum 25(OH)-vitamin D, while negatively with spKt/v and serum iPTH. In multiple regression analysis, serum sclerostin levels were associated significantly and independently with age, sex, BMI and serum iPTH. Compared to patients with normal BMD (T score≥-1s), the patients with low BMD (T score<-1s) had lower serum sclerostin level [142.97(99.52, 226.02) vs 201.13(107.40, 327.84) pmol/L, P=0.035]. Serum sclerostin levels were correlated significantly and positively with calcaneus BMD. Multivariate logistic regression analysis showed that serum sclerostin level was an independent protective factor for low BMD in MHD patients[OR=0.241, 95%CI (0.078, 0.749), P=0.014].    Conclusions    Serum sclerostin levels are associated with mineral disorder and bone density. Sclerostin may become a promising marker of bone turnover in MHD patients.