TNFSF11 and Hypocalcemia: In the ranking of efficacy for improving femoral neck BMD, denosumab and calcium topped the list, followed by vitamin D. Denosumab, a RANKL inhibitor, effectively suppresses osteoclast activity and increases bone density without being affected by renal function, thus demonstrating superior efficacy in the femoral neck region of KTRs (48, 50, 51).Calcium supplementation, primarily used to ameliorate hypocalcemia and maintain bone health, has limited efficacy when used alone and typically requires combination with other drugs (52).