For our 68th episode, we look at a paper in The Journal of Clinical Endocrinology & Metabolism that compares the effect on calcium of initial and subsequent doses of denosumab in people with chronic kidney disease (CKD). Though concerns have arisen over the years about the problems with stopping denosumab therapy, it remains an appealing medication for some of our patients with CKD. So we thought this report had the potential to change our practice and gave us the opportunity to delve into the challenges around osteoporosis in CKD. Host Chase Hendrickson, MD, MPH, MHCC, from Vanderbilt University talks with regular contributor Amal Shibli-Rahhal, MD, from University of Iowa Carver College of Medicine, and guest expert Kristin Clemens, MD, from St. Joseph’s Hospital and Western University in London, Ontario, Canada. They discuss “Dose-Specific Effects of Denosumab on Serum Calcium Levels in Patients With Osteoporosis and Various Renal Functions” by Sun et al, published in the July 2025 issue of JCEM.