People with chronic kidney disease commonly develop problems with their bones. The bones tend to become weak, which causes them to break easily or to begin to hurt. Normal bone is continually replacing itself. The two types of bone disease are high turnover, where bone is too active and low turnover, where bone is not active enough to keep the bones healthy. The most common types of bone disease occur when the levels of phosphorus, calcium and Parathyroid Hormone (PTH) in body are not properly balanced. This can happen for a number of reasons such as a change in the way the body processes Vitamin D and removes phosphorus. The doctor will find out what type of bone disease one may have by examining the patient and doing certain blood tests. In some cases, a bone biopsy may also be needed. 
Too much phosphorus in blood is a major factor in causing bone disease in people with kidney disease. While phosphorus stays in the body when kidneys can no longer remove it, calcium levels of the blood tend to drop. The combination of high phosphate and low calcium causes the parathyroid glands (four small glands in the neck) to become overactive and secrete too much hormone which affects bone. When this happens over a long period of time it may cause the bones to weaken or become painful.
Vitamin D is a mineral that is important to healthy bones because it affects calcium balance in the blood. Normally, Vitamin D is absorbed from exposure to sunlight on the skin, the food we eat, and vitamin and mineral supplements. Vitamin D is transformed by kidneys into an “active” form that can be used by our body. When kidneys are no longer working well, they cannot do this important job. “Active” forms of Vitamin D are available as a medication and can be prescribed by the doctor if required (excess vitamin D may result in bone calcification so it should NOT be taken without doctor’s advice.
In the past, people with chronic kidney disease were given aluminum to bind phosphate. In some, the long-term use of aluminum-containing medications led to bone problems. Now, aluminum containing
phosphate binders are not used as much, but can still be good at decreasing phosphorous levels on occasion.
Metabolic acidosis is a condition when the body’s acid/ alkaline balance is disturbed.