How do you approach treatment of osteoporosis in patients with CKD who develop a fragility fracture while on denosumab?  

The only option left at this point is a PTH compound. Please it or not, it still works every time in subjects with a secondary elevation of PTH. I would try either Forteo or Tymlos for a few months and see if the patient can tolerate it and if the calcium numbers remain stable. I am not sure about r...