Treatment of Adynamic Bone Disorder With Parathyroid Hormone in Chronic Kidney Disease

Inclusion Criteria: * Age ≥18 years * CKD stage 4-5D (eGFR ≤29 ml/min) according to Kidney Disease Improving Global Outcomes(KDIGO) definition * DXA scan with a T-score at the total hip, femoral neck or lumbar spine (L1-4) ≤-2 (or Z-score ≤-2) in a minimum of 2 vertebraes (for patients with active oral prednisolone treatment ≥ 5 mg/day for minimum 3 months the T-score or Z-score limit i \< -1) and/or former fragility fracture (vertebral, hip, for- or upper arm, ankle) assessed with VFA or x-ray of the columna * Patients with expected adynamic bone disorder, based on BSAP≤21 µg/l or biopsy-verified low bone turnover Exclusion Criteria: * Hypercalcemia defined as sustained ionized calcium \>1.35 mmol/l * Previous fracture withon the last 6 months \*Patients may be rescreened after the 6 months * Previous calciphylaxis * Thyroid disturbances not adequately treated based on the opinion by the clinician \*Patients may be rescreened after treatment optimization * Treatment with digoxin * Paget's disease or other metabolic bone disorders * Antiresorptive or bone anabolic medication during the last 24 months (for bisphosphonates it is only during the last 12 months) * Former or present malignant disease (except skin basal or planocellular carcinoma) * Previous external beam or implant radiation therapy to the skeleton * Patients who have undergone a kidney transplantation within the last 12 months * 25 hydroxyvitamin D2 and D3 \<50 nmol/l \*Patients may be rescreened after correct…