Objective The aim of the present study was to evaluate the indication and security of low-calcium dialysate (LCD) for adynamic bone disease (ABD) in senile patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Methods Twenty-four senile ABD patients(age＞60 years) who underwent CAPD (intact parathyroid hormone(iPTH)＜100 ng/L) were enrolled. LCD (Ca 1.25 mmol/L) was used in dialysis treatment instead of standard-calcium dialysate (SCD, Ca 1.75 mmol/L). At 1-, 2-, 6-, 9-, 12-, 18-month follow up respectively, the biochemical measurements were performed for plasma levels of i-PTH, calcium, phosphorus, calcium-phosphorus product and alkaline phosphatase(AKP). Additionally, the bone mineral density (BMD) was also detected. Results After using LCD, the level of plasma iPTH began to upgrade in the first month; increased evidently in the second month [baseline vs 2-month: (46.16±22.58) vs (131.10±75.78)ng/L, P＜0.01]; increased gradually at month 6, 9 and 12; maintained stable and remained in target range since 12-month(150~300 ng/L). The percentage of patients whose serum iPTH level reached to target range augmented gradually in initial 12 months of treatment, which at month 2, 6, 9, 12 were 53.5%, 57.2%, 66.7%, 72.9% respectively. The percentage did not change significantly during the following 6 months(71.6% and 73.3% at 15- and 18-month respectively). At 2-month, level of serum calcium, phosphorus and calcium-phosphorus product all declined significantly[serum calcium level: (2.60±0.21) vs (2.12±0.18)mmol/L; serum phosphorus level: (1.96±0.53) vs (1.43 ±049)mmol/L; calcium-phosphorus product scores: (63.36±19.14) vs 48.79±20.03)mg2/dl2, P＜0.01]. Meanwhile, the level of serum AKP increased from (107±72)IU/L to (176±89)IU/L (P＜0.05). The incidence of osteoporosis increased by 12.5%. The majority of patients tolerated LCD well, without sufferring from severe hyperspasmia, alteration of psyche, hypotension or catagma. Conclusions LCD can effectively increase iPTH level and improve calcium and phosphorus metabolism in senile ABD patients undergoing CAPD, thus to treat ABD satisfactorily, with good security. However, LCD, to some extent, increases the incidence of osteoporosis. So, for these patients, ABD should be taken into consideration, as well as osteoporosis.