Renal osteodystrophy (ROD) , which is most evident in patients on chronic kidney disease-mineral and bone disorder (CKD-MBD) , usually begins when the kidney function starts to deteriorate. The spectrum of skeletal abnormalities seen in ROD is classified according to the state of bone turnover, especially by bone biopsy. In 2003, the Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines were released for the treatment of CKD-MBD.