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?

How do you use PTH to assess for adynamic bone disease in a patient with advanced CKD receiving denosumab?

• Check PTH and bone-specific alkaline phosphatase before starting only
• Check PTH and bone-specific alkaline phosphatase before starting and periodically during therapy
• Reserve assessment for bone biopsy when adynamic bone disease is suspected
• Don't routinely check turnover markers for this purpose
• Avoid denosumab in advanced CKD
• Other