Treatment strategies for renal bone disease.

Renal bone disease encompasses a wide range of bone abnormalities that are intricately linked with metabolic systems that are driven by calcium, phosphorus, PTH, and D hormone levels. An integrated approach to treatment must involve both dietary measures, use of phosphate binders as appropriate, and D hormone replacement. Not incidentally, implementation of this integrated approach involves not only our patients but everyone associated in their care, especially the nephrologist, nephrology nurse, and renal dietitians. Improving patient outcomes--preventing or minimizing renal bone disease and the complications of secondary hyperparathyroidism--will require communication and cooperation between all of us on behalf of our patients.