Background: Pathological fracture diagnosis is on rise. The morbidity involved doesn't only load the patients and their families but it has a great cost on the health care system as well. Aims of the Study were to estimate the prevalence and assess risk factors for pathological fracture among patents with end stage renal disease. Patients and Methods: Overall, 500 patients on maintenance hemodialysis (HD) were included in a descriptive crosssectional study. The study was conducted at Assiut University Hospitals (Assiut – Egypt). Data pertinent to the study was collected by utilizing the following tool: Patients' structured interview assessment sheet: it included two parts: Part one: sociodemographic data. Part two: clinical assessment data. Results: 6.8% of the studied sample had exposed to pathological fracture where the hip, radius/ ulna, and vertebra were the most common sites affected. In univariate logistic regression; it was found that six factors had significant predicted relations with pathological fracture (duration of hemodialysis, overweight, coronary artery diseases, radiation exposure, parathyroidectomy, and pancreatic diseases) while in multivariate logistic regression; it was found that three factors (duration of hemodialysis, radiation exposure, and parathyroidectomy) were significant as in univariate logistic regression plus four factors (age, sex, diabetes, and hypertension) which were significant too. Conclusion: In our study the prevalence of pathological fracture among end stage renal disease patients occurred by 6.8% and there was significant relation between pathological fracture & ten risk factors. Recommendations: Early identification of the patients who are at risk for pathological fracture is a valuable tool to cut cost and improve patients’ quality of life.