PTH and fibrosis: The serum parathyroid hormone level is positively correlated with bone turnover in CKD-MBD.[16] Additionally, an increased level of parathyroid hormone results in bone fibrosis and deficient bone mineralization.[17] In this case, the parathyroid hormone level was not high, and the bone fibrosis was quite mild; hence, it was unlikely that secondary hyperparathyroidism significantly contributed to the development of her bone disease.