Objective: To explore the correlation between musculoskeletal ultrasound changes and markers of bone metabolism in patients with gout. Methods: A total of 155 gout patients who underwent musculoskeletal ultrasound examination in our hospital from May 2019 to May 2021 were selected and divided into three groups according to the ultrasound results. Patients with no ultrasonographic lesions were classified into group A (n=48). Patients with gout stone or aggregation or double track sign were classified into group B (n=55). Patients with ultrasonographic erosion accompanied with or without gout stone, aggregation or double track sign were classified into group C (n=52). The levels of bone metabolism markers of bone GLA protein (BGP), Cross linked C-telopeptide of type I collagen (CTX-I), and osteopontin (OPN) were compared in each group. And analyze their correlation with clinical indicators. Results: The levels of BGP and OPN in group C were significantly higher than those in group B and group A (P<0.05), and the levels of BGP and OPN in group B were significantly higher than those in group A (P<0.05). Pearson correlation analysis showed that serum BGP and OPN levels were positively correlated with the course of disease (P<0.05). There was no significant correlation between levels of serum uric acid and BGP or OPN (P>0.05). Conclusion: Musculoskeletal ultrasound can reflect the degree of joint bone damage in patients with gout, which can be used as an imaging method for evaluating the degree of joint involvement in gout.