As GFR declines in chronic disease, the ability of the kidney to regulate calcium and phosphate levels is altered. The kidneys are no longer able to excrete excess phosphate and activate vitamin D. As the level of phosphate in our blood increases, our calcium levels decrease from reduced absorption from our intestinal tract. This causes an increased release of parathyroid hormone (PTH). The parathyroid hormone works to regulate the amount of calcium and phosphate in the blood. When our calcium levels drop, the parathyroid hormone enhances the release of calcium from our bones. This can lead to a condition called renal osteodystrophy. Renal osteodystrophy can cause symptoms like bone pain, fractures, weakness, tumors in bones, and itchiness. It could further lead to bone deformities and calcium being deposit throughout our body. Ways to manage bone and mineral management include, taking phosphate binders, calcium supplements, and vitamin D therapy.