Nature Reviews Nephrology, Published online: 16 June 2026; doi:10.1038/s41581-026-01095-9Osteoporosis in chronic kidney disease (CKD) grade 4–5D constitutes a profound burden and the treatment gap remains unacceptably wide. People with advanced CKD and osteoporosis should receive comprehensive treatment based on available data, and there is an urgent need to expand the evidence base through inclusion in osteoporosis clinical trials.
