Renal osteodystrophy includes a variety of skeletal disorders such as high turnover lesion and low turnover lesion Bone biopsy remains the gold standard to distinguish between different types of renal osteodystrophy. This study was designed in order to evaluate and compare the use of PTH, osteocalcin and dual energy x ray absorptiometry to elaborate a non-invasive assesment of renal osteodystrophy and thus be able to aviod bone biopsy. Seventy patients with chronic renal failure maintained on regular hemodialysis were estimated by measuring : serum urea, creatinine , ALT AST , calcium , inorganic phosphorus , total alkaline phosphatase , intact parathyroid hormone ,Serum osteocalcin and quantification of bone density using the dual energy x ray absorbtion technique .The results of the study showed that 27.1% of patients had normal PTLI values, 52.85 % of patients had an increase in PTH reaching three folds the normal value , while 20% of patients had an increase in serum level of parathyroid hormone of more than three folds of normal. Osteocalcin was markedly elevated in all patients included in this study. 32.85 % of the patients had T score more than - 2.5 while the majority 67.14 % of patients had T score less than -2.5 which indicate osteoporosis. Our study did not find any significant correlation between each of PTH, serum osteocalcin and T score .A significant correlation was found between the PTH level and total alkaline phosphatase, a significant correlation between osteocalcin and urea, a significant correlation between osteocalcin and creatinine , a significant correlation between osteacalcin and serum phosphorus and a significant correlation between osteocalcin and serum calcium was also found . An inverse correlation was found between age and T score of the study patients and a Significant difference in the duration of dialysis was found between the two groups (Tscore <-2.5 and Tscore > - 2.5). In conclusion: the combined estimation of PTH, osteocalcin and bone density by dual energy x ray absorptiometry may provide useful information on the bone status in uremic patients.