Since secondary hyperparathyroidism (SHPT) characterized by persistent elevated parathyroid hormone (PTH) and marked parathyroid hyperplasia is the leading cause of osteitis fibrosa cystica [8], the current recommended treatment for renal osteodystrophy is to manage secondary hyperparathyroidism, but not typical osteoporosis therapies. Here, PTH is linked to parathyroid hyperplasia.