Take Home Message

Bone disorders contribute substantially to morbidity and impaired patient quality of life in CKD.

Impaired phosphate excretion, reduced synthesis of active vitamin D, secondary hyperparathyroidism, and dysregulation of FGF23 and sclerostin, together with chronic inflammation and immune dysregulation, are involved in the disruption of bone remodeling in CKD.

REMS is a radiation-free ultrasound-based technique for estimating bone mineral density with the ability to capture structural features that are not fully reflected by conventional densitometry.

Treatment of osteoporosis in CKD includes osteoanabolic and antiresorptive drugs; in particular, Romosozumab, with its combined anabolic and antiresorptive properties, represents a promising option.

β-Cross Laps reflects osteoclastic bone resorption, while osteocalcin reflects osteoblastic bone formation; however, their use in advanced CKD is limited due to renal-dependent clearance.

Bone markers independent of renal clearance include BSAP and intact P1NP for bone formation, and TRAP-5b for bone resorption. Integrating these clearance-independent markers with clinical evaluation and imaging techniques enhances bone turnover characterization, fracture risk stratification, and osteoporosis management.