Objective To explore the characteristics of bone and calcium-phosphorus metabolism in elderly maintenance hemodialysis (MHD) patients with type II diabetes kidney disease (DKD) or non-DKD. Methods During the period of 2006 to 2010, peripheral blood samples were taken from 90 elderly end-stage renal disease (ESRD) patients due to type II DKD and 120 elderly ESRD patients of non-DKD to measure their plasma levels of osteocalcin (OT), β-crosslaps, parathyroid hormone (iPTH), calcium (Ca), phosphorus (P) and Ca+2 before MHD, and on MHD for 1 year, 3 years and >5 years. Results When comparisons were made for the laboratory parameters taken before MHD, and on MHD for 1 year, 3 years and >5 years, plasma levels of OT, β-crosslaps and iPTH were found to be lower in patients on MHD for 1 year, 3 years and >5 years, especially in those on MHD for 1 year (P＜0.05), than those before MHD; plasma Ca was higher in those on MHD for 1, 3 and >5 years (P＜0.01); plasma P was lower in the patients with DKD and on MHD for 1 year, but was higher in the patients with non-DKD and on MHD for 3 years. When comparisons were conducted between the laboratory parameters from MHD patients with DKD and those with non-DKD, plasma levels of OT, β-crosslaps, iPTH and P were found to be lower in the patients with DKD before MHD and on MHD for 1 and 3 years, especially in those before MHD and on MHD for 3 years (P＜0.05); plasma Ca was indifferent in MHD patients with DKD and those with non-DKD. Conclusions As MHD lasted longer in elderly patients with DKD, they exhibited distinct clinical manifestations and pathogenesis in bone and calcium-phosphorus metabolism. Specific management to these clinical features is usually required.