Abstract： Objective To investigate the changes of bone mineral density(BMD)and serum osteocalcin(BGP)in elderly patients with hypertension and hyperhomocysteinemia(HHcy). Methods Eighty-five elderly patients with hypertension and HHcy(the study group),who were hospitalized in our hospital between July 2012 and December 2015,were included in the study. A contemporary cohort of 50 healthy elderly volunteers was included as the control group. The blood pressure,serum homocysteine (Hcy),blood lipid level,BMD,and serum BGP level in the subjects were compared between the two groups. The correlations between the blood pressure,serum Hcy,blood lipid level and BMD,serum BGP level were analyzed. Results The systolic blood pressure,diastolic blood pressure,serum Hcy,total cholesterol(TC),triglyceride(TG)and low density lipoprotein(LDL)levels in the study group were significantly higher than those in the control group,whereas the serum high density lipoprotein(HDL)level were significantly lower than that in the control group(all P<0.05).The BMD level in the female subjects was significantly lower than that in the male subjects of the same group,whereas the serum BGP level was significantly higher than that in the male subjects of the same group(both P<0.05).The correlation analysis showed that there was a negative correlation between the BMD and the serum Hcy,TC,TG,LDL levels,but positively correlated with the serum HDL level in elderly patients with hypertension and HHcy(r=-0.783,-0.573,-0.526,-0.637,0.473,all P<0.05);And the serum BGP level was positively correlated with the serum Hcy,TC,TG,LDL levels,but negatively correlated with the serum HDL level(r=0.637,0.362, 0.372,0.388,-0.726,all P<0.05). Conclusion The incidence of osteoporosis is high in the elderly patients with hypertension and HHcy,who show decreased BMD and increased serum BGP level.It should be paid more attention in the clinical settings.