What are some practical tips in distinguishing between metabolic bone disease due to chronic kidney disease and osteoporosis?

The biggest difference between osteoporosis and CKD-MBD has to do with the underlying bone mineral laboratories. Generally, with osteoporosis, bone chemistries are relatively normal; there may be a decrease in Vit D. However, with CKD-MBD, there is usually an increase in PTH, potentially abnormalities in Phos, and increased creatinine associated with CKD. Also, maybe changes in FGF 23 if you want to further investigate.