Introduction: Many patients under hemodialysis, have osteopenia or even osteoporosis by the definition of the World Health Organization based on bone mineral density (BMD). Dual-energy X-ray absorptiometry (DXA), the standard method to assess BMD, is not always available. Quantit-ative ultrasound (QUS) of phalanx is an inexpensive, mobile, and radiation-free diagnostic alterna-tive. There is few data about correlation of this method with DXA in patients undergoing hemo-dialysis. The present study assessed the value of QUS in detecting changes in bone structure in pat-ients under hemodialysis compared with DXA. Materials and Methods: The patients had End Stage Renal Disease (ESRD) who was referred for Bone densitometry in BMD ward of EMRC. BMD of the hip (neck and total) and spine was measu-red using a GE-Lunar DXA device (DPX-MD). QUS of phalanx was done in all of them using a DBM-Sonic 1200 device. This device measures amplitude dependent speed of sound (Ad-SOS). SPSS (10) was used for statistical analysis. ROC curve was drawn to measure the sensitivity and specificity of QUS of phalanx. P- Value less than 0.05 were considered as significant. Results: In a cross-sectional analysis, 64 patients (37 men) with a mean age of 51.33+-15.20 years and mean dialysis time of 49.45+-45.62 months (2-180), were studied. DXA measurements established the diagnoses of osteoporosis in 31.3% in any of the total of femur or neck of femur or L2-L4 regions (25% in Neck , 18.8% in Total , 7.9% in L2-L4 regions).Using QUS of phalanx, osteoporosis diagnosed in 28.1% of patients . Using ROC curve, sensitivities of T-score ≤-2.5 of phalanx for diagnosing of osteoporosis in neck and total of hip and L2-L4 regions were respectively 37.5% and 50% and 80% and specificities were respectively 75% and 77% and 76%. Area under curve for neck, total and spine regions were 0.692 (P-value=0.022), 0.701 (P-value=0.031), 0.809 (P-value=0.023), respectively. Conclusions: QUS of phalanx can be recommended for screening osteoporosis among hemodialysed patients. Those suspected of osteoporosis, should be examined by additional DXA measurement for establishment of diagnosis.