There is limited information about osteoporosis in end stage renal disease (ESRD) patients. We studied bone mineral density (BMD) changes in Iranian patients with ESRD. In 57 ESRD patients that were candidate for renal transplantation, bone mineral density at fem neck and spine were assessed using a DEXA Norland scanner, stepwise multiple linear regression analysis were used to identify risk factors associated with low bone density. Mean BMD, T-score and Z-score of fem neck and spine were significantly reduced (respectively, at the fem neck: 0.78±0.14; -2.4±1.1; - 1.6±1.0 and at the spine: 142.25±105; -1.09±1.1; -1.07±0.9). Osteoporosis and osteopenia were found 55.2% and 36.2% at fem neck and 8.6% and 58.6% at spine. There were significant correlation between fem SBMD and spine SBMD (r=0.448). The BMD had significant negative association with age (r=0.615), female gender (r=0.394) and corticosteroid intake (r=0.286) and positive association with weight (r=0.394), and BMI (r=0.626). There was no significant association between BMD measurements and calcium, phosphorous and PTH levels. Follow up of 11-months, after renal transplantation of 20 patients, subject had lost a mean of 2.4% T-score and 2.8% Z-score at the lumbar spine (p=0.027 and 013, respectively), but did not experience significant declines at the fem neck. Low bone density is too common in ESRD Iranian patients. Early screening and treatment of this group and importance of calcium supplement in prevention of osteoporosis is recommended. Significant loss in lumbar T-score and Z-score occurred within 11 months of transplantation in more than one third of a prospective cohort of renal transplant recipients.