Objective  To explore the association of nutrition and inflammation with bone metabolism and cardiovascular calcification in elderly patients undergoing hemodialysis (HD).  Methods Elderly patients (age>60 years) undergoing HD who were treated at the 983th Hospital of PLA Joint Logistic Support Force between January 2020 and December 2024 were retrospectively enrolled as the study group, while elderly individuals undergoing routine health examinations during the same period were enrolled as the control group. Serum nutritional indexes [albumin (ALB), prealbumin (PA), and transferrin (TRF)], inflammatory indexes [C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6)], bone metabolism indexes [bone gla-protein (BGP), parathyroid hormone (PTH), and N-terminal propeptide of type I procollagen (PINP)], as well as hemoglobin (Hb), serum creatinine (Scr), blood urea nitrogen (BUN), blood calcium, blood phosphorus and alkaline phosphatase (ALP) were compared between the two groups. The correlation between serum nutritional indexes, inflammatory indexes and bone metabolism was analyzed by Pearson correlation analysis. According to the presence or absence of cardiovascular calcification, patients were divided into non-calcification group and calcification group, and serum indexes in the two groups were compared. The risk factors of cardiovascular calcification were analyzed by Logistic regression analysis, and patients’ diagnostic efficiency for cardiovascular calcification was evaluated by ROC curves.  Results  There were 195 patients in the study group and 195 individuals in the control group, respectively. The levels of ALB, PA, TRF, BGP and Hb in the study group were lower than those in the control group (t=30.709, 21.301, 14.406, 34.047, 28.805, all P＜0.001). The levels of CRP, TNF-α, IL-6, PTH, PINP, Scr and BUN in study group were higher than those in the control group (t=32.416, 28.101, 24.524, 36.802, 29.094, 52.846, 38.140, all P＜0.001). Among in the study group, the levels of ALB, PA, TRF, BGP, blood calcium and Hb in the calcification group were lower than those in the non-calcification group (t=8.667, 9.082, 3.061, 4.389, 5.642, 3.003, P＜0.001, ＜0.001, 0.003, ＜0.001, ＜0.001, 0.003), whereas the levels of CRP, TNF-α, IL-6, PTH, PINP, blood phosphorus, ALP, Scr and BUN, age and dialysis vintage were higher than those in non-calcification group (t=4.529, 3.892, 3.477, 4.732, 2.782, 3.813, 2.094, 4.268, 3.882, 4.871, 2.052; P＜0.001, ＜0.001, 0.001, ＜0.001, 0.006, ＜0.001, 0.038, ＜0.001, ＜0.001, ＜0.001, 0.042, respectively). Pearson correlation analysis showed that ALB (r=0.412, -0.523, -0.385, all P＜0.001), PA (r=0.368, -0.486, -0.356, all P＜0.001) and TRF (r=0.395, -0.508, -0.472, all P＜0.001) were positively correlated with BGP, and negatively correlated with PTH and PINP. CRP (r=-0.358, 0.456, 0.336, all P＜0.001), TNF-α (r=-0.325, 0.423, 0.312, all P＜0.001) and IL-6 (r=-0.342, 0.445, 0.328, all P＜0.001) were negatively correlated with BGP and positively correlated with PTH and PINP. Logistic regression analysis showed that lower ALB levels (OR=0.882, 95%CI: 0.813～0.958, P=0.003), lower PA levels (OR=0.816, 95%CI: 0.676～0.985, P=0.023), higher CRP levels (OR=1.070, 95%CI: 1.015～1.129, P=0.012), lower serum calcium levels (OR=0.271, 95%CI: 0.080～0.921, P=0.037) and longer dialysis vintage (OR=2.892, 95%CI: 1.048～7.983, P=0.041) were independent risk factors for cardiovascular calcification in elderly HD patients. ROC curves analysis showed that ALB (AUC=0.810, P＜0.001), PA (AUC=0.824, P＜0.001), TRF (AUC=0.608, P=0.006), CRP (AUC=0.685, P＜0.001), TNF-α (AUC=0.627, P=0.002) and IL-6 (AUC=0.611, P=0.004) had significant diagnostic value for cardiovascular calcification. The AUC of the combined model was 0.913, which was greater than the AUCs of the individual index (all P＜0.050).  Conclusion  Nutrition and inflammatory status were closely associated with bone metabolism in elderly patients undergoing HD. Nutritional and inflammatory indexes showed diagnostic value for cardiovascular calcification, and their combination provided better diagnostic performance than individual indexes.