Off-label prescription of teriparatide may be an option in those patients with low to normal bone turnover and/or serum PTH values that are appropriate to or lower than expected for their stage of CKD, with BMD T scores < −3 and multiple fractures, particularly if they have sustained a fracture while on denosumab or bisphosphonate, although this remains to be tested. Here, PTH is linked to chronic kidney disease.