abstract Background: Coronary tortuosity (CT) is commonly encountered in postmenopausal females and is usually present without obstructive lesions. Circulating sclerostin levels are elevated in postmenopausal females. In view of sclerostin's vasculoprotective effect, we aimed to find possible association between circulating sclerostin and CT. Method: Weprospectively enrolled 273 consecutive postmenopausal females with non-obstructive coronary artery disease diagnosed by coronary angiography. Presence and severity (by tortuosity score) of CT as well as serum sclerostin levels were assessed for each patient. Results: Patients with CT(128,47%ofstudygroup)weresignificantlyolder(P<0.001),withhigherprevalenceof hypertension (P = 0.001) and had significantly higher levels of both sclerostin (P < 0.001) and hs-CRP (P = 0.001). Multivariate binary logistic regression revealed that the presence of CT (dependent variable) was associated withhighsclerostinlevel (OR 8.9,95% CI: 4.9–16.2, P < 0.001).UsingROC curveanalysis, Sclerostinata cutoff value of >650 pg/ml wasfoundtobeassociatedwithpresenceofCT(AUC0.69,95% CI:0.61–0.75, P <0.001) with sensitivity and specificity of 75% and 72.4%, respectively. Using Pearson's correlation analysis, significant positive correlation between sclerostin and severity of CT was found (r =0.29,P =0.001). Conclusion: High circulating sclerostin is associated with the presence and severity of CT in postmenopausal females. This may add to the literature on the incompletely understood pathogenesis of CT.