The measurement of calcium, phosphate, vitamin D, and PTH identify metabolic abnormalities associated with CKD‐MBD, but these remain poor markers of ROD and have insufficient discrimination of ROD turnover type and mineralization.8, 9 Bone turnover markers (BTMs), routinely used in non‐CKD patients to monitor fracture risk and osteoporosis therapy, lack validation in CKD and end‐stage chronic kidney disease (ESKD) and are consequently used infrequently. This evidence concerns the gene PTH and Marchiafava-Bignami disease.