The aim of the present work was to demonstrate the ability of dual energy X-ray absorptiometry (DEXA) to predict the overall risk of fractures in dialysis patients. A prospective study of 522 patients (271 men, 251 women) receiving long-term hemodialysis in dialysis centers in St. Petersburg was carried out. Cox stepwise multivariate regression analysis showed that a combination of measures of bone mineral density in the lumbar vertebrae and the distal bones of the forearm and the duration of kidney replacement therapy provided the best prediction of overall fracture risk. Conclusions: DEXA is a convenient tool for assessing facture risk in patients on hemodialysis.