Is there a role for monitoring PTH levels in patients with advanced chronic kidney disease who are receiving denosumab in order to assess for adynamic bone disease?

It is more important to monitor PTH and bone-specific alkaline phosphatase prior to the initiation of denosumab. If PTH and bone-specific alkaline phosphatase are suggestive of adynamic bone disease, I would recommend a bone biopsy to rule out adynamic bone disease prior to the initiation of denosum...