Objective To investigate the correlation of uric acid (UA) levels with bone mineral density (BMD) and serum bone metabolic markers in middle-aged Chinese physical examination population, so as to discuss the possible role of UA in bone metabolism. Methods A cross-sectional study with 214 middle-aged (45 to 65 years) Chinese physical examination participants was carried out. The correlation of UA levels with BMD and serum bone metabolic markers was observed. BMD values of the lumbar spine, total hip, femur neck and the whole body were measured by dual energy X-ray method. Bone turnover markers, including bone formation markers osteocalcin (OC) and procollagen type Ⅰ amino-terminal propeptide (PⅠNP), bone resorption marker β-CrossLaps (β-CTX), 25-hydroxyvitamin D₃ (25-OHD₃), and parathyroid hormone (PTH) were measured by ECL immunoassay. Results After adjusting for multiple confounders, serum UA levels were found positively correlated with BMD at the lumbar spine, total hip and whole body (P≤0.001), negatively correlated with OC (P<0.01), and positively correlated with logPTH and log25-OHD₃ (P=0.039, P=0.032). The participants were divided into high UA group (UA≥60 mg/mL) and low UA group (UA<60 mg/L) according to the serum UA level. OC, PⅠNP and β-CTX were found significantly lower in the high UA group than in the low UA group (P<0.01). Then we divided the participants into three groups (T1: UA <47 mg/L,T2: 47 mg/L≤UA <60 mg/L; T3: UA≥60 mg/L) according to the serum UA level, and we found that the odds for osteoporosis and at least osteopenia increased by 41% and 158% in T1 group compared with in T3 group, respectively. Conclusion UA plays a protective role in bone metabolism of middle-aged Chinese population, and the relative conclusions need to be confirmed by further studies.