<unk>  is usually diagnosed after treatment for end-stage kidney disease begins; however the CKD-MBD starts early in the course of CKD. In advanced stages, blood tests will indicate decreased calcium and calcitriol (vitamin D) and increased phosphate, and parathyroid hormone levels. In earlier stages, serum calcium, phosphate levels are normal at the expense of high parathyroid hormone and fibroblast growth factor-23 levels. X-rays will also show bone features of<unk>  (subperiostic bone resorption, chondrocalcinosis at the knees and pubic symphysis, osteopenia and bone fractures) but may be difficult to differentiate from other conditions. Since the diagnosis of these bone abnormalities cannot be obtained correctly by current clinical, biochemical, and imaging methods (including measurement of bone-mineral density), bone biopsy has been, and still remains, the gold standard analysis for assessing the exact type of<unk> . File:X-ray of periosteal reaction in<unk> .Projectional radiography ("X-ray") of periosteal reaction. File:X-ray of ground glass density of the skull by<unk> .Ground glass density of the skull. File:CT of sclerotic lesions in the skull in<unk> .CT shows focal areas of osteosclerosis. File:X-ray of brown tumors in the pelvis and a hip fracture in<unk> .Brown tumors in the pelvis and a hip fracture. File:CT of subchondral resorption in the SI joint in<unk> .Subchondral resorption in the sacroiliac joint. File:X-ray of rugger-jersey spine of<unk> .X-ray of a subtle "rugger jersey spine" due to sclerotic bands adjacent to the vertebral endplates. File:CT of rugger-jersey spine of<unk> .CT scan of the same case. Differential diagnosis To confirm the diagnosis,<unk>  must be characterized by determining bone turnover, mineralization, and volume (TMV system) (bone biopsy). All forms of<unk>  should also be distinguished from other bone diseases which may equally result in decreased bone density (related or unrelated to CKD): * osteoporosis * osteopenia * osteomalacia * brown tumor should be considered as the top-line diagnosis if a mass-forming lesion is present.
Renal osteodystrophy
Secondary hyperparathyroidism
Primary hyperparathyroidism
AA amyloidosis
Oncogenic osteomalacia
Phosphate nephropathy
Tertiary hyperparathyroidism
Osteolathyrism