Bone fracture risk in patients with chronic kidney disease (CKD) is much higher than that in healthy subjects. Frailty caused by neuromuscular impairment as well as bone fragility due to bone loss and impaired bone quality is thought to be involved in the elevated fracture risk in CKD. Altered material and structural properties might be attributed to the reduced bone strength. The structural properties in CKD patients are characterized in 1) cortical thinning and cortical porosity, and 2) irregular thickening and loss of connectivity in trabecular bone. Interestingly, recent findings suggest that skeletal changes in the structural properties may be initiated at earlier stage of CKD than we expected.