Osteodystrophy has become a frequent complication in chronic renal failure. The present study has been aimed to evaluate the role of tartrate-resistant acid phosphatase (TRACP) in patients with end stage renal disease (ESRD). Forty patients with (ESRD) who underwent hemodialysis and 37 age-and gender-matched healthy individuals were included in the study. Several biochemical parameters, such as the activities of total acid phosphatase (ACP), tartrate-resistant acid phosphatise (TRACP), prostatic acid phosphatase (PAP) and alkaline phosphatase (ALP), as well as testosterone, calcium and phosphorus concentrations were measured to evaluate the bone complication in ESRD patients. The results indicated presence of a significant increase (P <0.001) in TRACP and ACP activities with non-significant difference in PAP activity (P >0.05) in sera of 25% of the studied patients. A significant increase (P <0.01) in ALP activity and phosphorus concentration (P <0.01) was also detected in the patients group. Meanwhile, a significant decrease in calcium concentrations (P <0.001) and testosterone level (P <0.01) were observed in the sera of these patients, in comparison with that of the control group. In conclusion, the overall results of this study enable us to classify the included ESRD patients into two groups with respect to bone remodeling: the first group with high turnover rate and the second group with a change in their remodeling rate. Furthermore, the increased phosphate concentration together with the decrease in calcium and testosterone levels in the sera of ESRD patients seems to be the main factors that cause metabolic disturbances and lead to development of renal osteodystropy.