Background: Hypertension and osteoporosis are two major age-related disorders. Several studies have shown greater Bone Mineral Density (BMD) in people receiving thiazides diuretics compared with controls. The benefit of Angiotensin Converting Enzyme Inhibitors (ACEIs) to improve bone metabolism has been supported by some clinical studies. Therefore, these drugs might be a part of the therapeutic regime for osteoporotic hypertensive elderly. Objective:  to compare between the effect of ACEIs and thiazides on BMD when used separated or combined in hypertensive elderly. Patients&method: A retrospective comparative study recruiting 171 participants who were aged 60 years and above from the outpatient clinics of Ain shams University Hospitals. The participants were divided into three groups: Group I: 57 participants receiving thiazides, Group II:   57 participants receiving combined ACEIs and thiazides, Group III:  57 participants receiving ACEIs. Each group was subdivided into two subgroups; older and younger than the median age (65years) of participants. Patients with systemic diseases or on drugs that affect BMD were excluded from the study. All participants were subjected to: BMD measurement at lumbar spine (L2-L4) and left femur neck using Dual-energy x-ray absorptiometry (DEXA)  [lunar DPX DEXA system]. Results: As regard lumbar (L2-L4) BMD T-score ,there was no significant difference found between the groups as a whole sample (P-value 0.383), nor the age subgroups ,when subdivided into two subgroups older than the median age (65 years old)(P-value 0.832) and from 65 years old and younger (P- value0.259) (the same was found as regard z-score). As regard BMD of the Left Femur Neck T-score there was no significant difference found neither between the groups as a whole sample (P-value 0.921), nor among the age subgroups when subdivided into two subgroups older and younger (p-value 0.889), (the same was found as regard z-score). conclusion: the current study found no evidence that there is a difference between thiazides therapy and ACEIs therapy as regard their effect on BMD in elderly hypertensive patients when used separated or combined.