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Recent reports demonstrate that carbamylation driven by high urea concentration aggravates <jats:styled-content style=\"fixed-case\">VC<\/jats:styled-content>, suggesting the importance of adequate dialysis in retarding its progression. Theoretically, other promising measures include the use of iron\u2010based phosphate binders, vitamin K, and magnesium supplements, which should be investigated in future randomized controlled trials (<jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>s), ideally with hard outcomes. While incidence of hip fracture in patients on dialysis is decreasing in the United States and Japan (possibly owing to better control of <jats:styled-content style=\"fixed-case\">PTH<\/jats:styled-content> levels by cinacalcet) it remains much higher than that in the general population. Many drugs used in the treatment of osteoporosis, including bisphosphonate, raloxifene, denosumab, and teriparatide can, under specific conditions, increase bone mineral density (<jats:styled-content style=\"fixed-case\">BMD<\/jats:styled-content>), which is associated with a lower fracture rate. However, the efficacy of these drugs in reducing the fracture rate remains to be proven in hemodialysis (<jats:styled-content style=\"fixed-case\">HD<\/jats:styled-content>) patients, given their adverse effects such as severe hypocalcemia and resultant worsening of secondary hyperparathyroidism. Some clinical studies have shown that cinacalcet, lanthanum carbonate, and sevelamer reduce mortality in elderly patients on <jats:styled-content style=\"fixed-case\">HD<\/jats:styled-content>, suggesting the benefits of reducing <jats:styled-content style=\"fixed-case\">PTH<\/jats:styled-content> and serum phosphate levels. However, the target ranges of <jats:styled-content style=\"fixed-case\">PTH<\/jats:styled-content> and phosphate levels are based solely on observational studies. This is also the case when treating low <jats:styled-content style=\"fixed-case\">PTH<\/jats:styled-content> levels by decreasing vitamin D or calcium load. <jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>s with hard clinical endpoints comparing different targets are necessary in the future.<\/jats:p>","DOI":"10.1111\/sdi.12729","type":"journal-article","created":{"date-parts":[[2018,6,14]],"date-time":"2018-06-14T03:11:11Z","timestamp":1528945871000},"page":"592-598","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Mineral and bone disorders in conventional hemodialysis: Challenges and solutions"],"prefix":"10.1111","volume":"31","author":[{"given":"Takayuki","family":"Hamano","sequence":"first","affiliation":[{"name":"Department of Inter\u2010Organ Communication Research in Kidney Disease Osaka University Graduate School of Medicine Osaka 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