This finding likely emphasizes a disorder of osteoblast maturation or increased mature osteocyte apoptosis [8,22,23], possibly mediated by PTH/PTHrP receptor down-regulation [12,26,27,28,29] and lower bone DMP1 expression in advanced CKD-MBD and overt hyperphosphatemia [23,36]. The gene discussed is DMP1; the disease is chronic kidney disease.