Objective To determine the relationship between circulating sclerostin levels and serum bone metabolism markers, bone mineral density (BMD) in postmenopausal women with or without fracture after falling, and to explore whether sclerostin can serve as a new biomarker to predict fragility fracture. Methods In this cross sectional and prospective study, 50 premenopausal women (group A), 50 postmenopausal women with femoral neck fracture after falling (group B) and 50 postmenopausal women without femoral neck fracture after falling (group C) were included. Observation items included serum sclerostin, bone metabolism markers and BMD. Results There were significant differences in bone metabolism markers (including C-terminal telopeptides of type Ⅰ collagen[CTXⅠ], C-terminal telopeptides of type Ⅱ collagen[CTXⅡ], bone alkaline phosphatase[b-ALP], procollagen type 1 N-propeptide[P1NP], receptor activator of NF-κB[RANK] and receptor activator of NF-κB ligand[RANKL]) among three groups (P<0.05, P<0.01). The protein levels of sclerostin (P<0.05, P<0.01) and osteocalcin (P<0.01) in the group B and C were significantly higher than that in the group A, but there was no statistical difference between the group B and C. There were significant differences in BMD at the site of lumbar spine (from L₁ to L₄), total hip, trochanter or femoral neck among three groups (P<0.01), and the BMD in the group B was significantly lower than those in the group A and C (P<0.01). There were significant negative correlations between serum sclerostin level and mean femoral neck BMD (r=-0.228, P=0.004), mean trochanter BMD (r=-0.199, P=0.002) and mean total hip BMD (r=-0.273, P<0.001). Conclusion There is no statistical difference in serum sclerostin between postmenopausal women with and without femoral neck fracture after falling, suggesting that serum sclerostin levels may not be used to predict the potential risks of fraglity fracture in postmenopausal women.