Objective To observe the changes of serum bone metabolism biochemical markers and bone mineral density (BMD) in patients with chronic kidney disease (CKD) at different stages, and to analyze their clinical correlation. Methods A total of 202 patients with CKD were divided into CKD1～5 group according to the estimated glomerular filtration rate (eGFR), and CKD stage 5 patients were divided into CKD 5ND and CKD 5HD groups according to the presence or absence of hemodialysis treatment. The biochemical? markers of bone metabolism and BMD (L1-4, hip joint, femoral neck)were observed among the six groups, and the risk factors of BMD were analyzed by logistic regression. Results ①With the progression of CKD stage, the BMD levels of femoral neck and hip joint decreased gradually, and the difference was statistically significant (P<0.05),while there was no significant difference in lumbar BMD level between different CKD groups (P>0.05). ②The levels of bone metabolism biochemical markers:the levels of PINP and β-CTx were significantly higher in the CKD 5HD group than in the CKD1～5ND group (all P<0.05), and the levels of 25 hydroxyvitamin D in the CKD 5ND group were significantly lower than those in the CKD1～4 group (all P<0.05). The P level of the CKD5 group was significantly higher than that of the CKD1～4 group (all P<0.05). The PTH levels in the CKD4 and CKD5 groups were significantly higher than those in the CKD1～3 groups (all P<0.05). ③Pearson correlation analysis showed that BMD of femoral neck and hip joint was negatively correlated with age, PINP, β-CTx, P, and PTH (P<0.05), and positively correlated with BMI, 25 hydroxyvitamin D, Hb, and Ca (P<0.05). BMD of the lumbar spine was negatively correlated with age (P<0.05) and positively correlated with 25 hydroxyvitamin D (P<0.05). ④Multiple linear regression analysis showed that age, β-CTx and PTH were risk factors for BMD in femoral neck and hip joint, and 25 hydroxyvitamin D was the protective factor. Ca and BMI were protective factors affecting BMD in femoral neck. Age is a risk factor for lumbar BMD, and 25 hydroxyvitamin D is a protective factor. Conclusion? With the progression of CKD, the lower the BMD level of hip and femoral neck, the more obvious the abnormal changes of bone metabolism biochemical markers, and the BMD of femoral neck and hip joint is negatively correlated with PINP, β-CTx, P and PTH. Early and regular combined detection of bone mineral density and bone metabolism biochemical markers in patients with CKD is helpful for the early diagnosis and management of renal osteodystrophy.