Nephrologists tend to be reluctant to treat osteoporosis, often because their primary focus is Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) and they may not feel comfortable managing osteoporosis therapies, mainly antiresorptives let alone osteoanabolics, i.e. PTH or its analogues. At the same time, non-nephrologists bone specialists often hesitate to treat osteoporosis in patients with CKD due to concerns about kidney function, medication safety, and the complexities of CKD-related bone disorders.

This divide has contributed to a treatment gap, where patients with CKD and osteoporosis are often undertreated or mismanaged. Instead of an integrated approach, osteoporosis and CKD-MBD are viewed as separate entities, even though they share overlapping pathophysiology, particularly in calcium and phosphate metabolism. This is precisely why bringing osteoporosis and CKD-MBD under the same umbrella is so critical—it encourages collaboration and a more holistic approach to bone health in patients with kidney disease.