It is of interest that in the general population, low bone mass is associated with a higher mortality rate due to atherosclerotic cardiovascular disease. In addition, the degree of aortic calcification is closely related with a lower bone mineral density (BMD). These results suggest that a low BMD may predict increased arterial stiffness. In ESRD patients, advanced arterial stiffness and low BMD due to renal osteodystrophy are not uncommon. Moreover, the initiation and progression of arterial stiffness and bone loss are accelerated by the same factors such as hyperphosphatemia secondary to chronic renal failure. A lower BMD might be more clearly associated with a higher PWV in dialysis patients than in the general population. To prove this hypothesis, we performed a preliminary cross-sectional study to investigate the relationship between BMD, as determined by calcaneal osteo-sono index (OSI), and arterial stiffness, as measured by the brachial-ankle PWV (baPWV). Our study demonstrated that calcaneal OSI, a marker for estimated BMD, has a powerful predictor of arterial stiffness, independent of classic risk factors, malnutrition, or inflammation markers. The evaluation of BMD needs to grasp not only the status of bone disease, but also the degree of arterial stiffness.