Management of mineral and bone disorders in Chronic Kidney Disease (CKD) is often challenging and nephrologists are faced with a conundrum of balancing treatment choices to prevent adverse clinical outcomes and minimising side-effects and pill burden for patients. Since the 2017 KDIGO CKD-MBD guidelines, there have been key development especially in the area of phosphate management and treatment for bone disorders and osteoporosis. This lecture will cover clinical perspectives of phosphate binders usage in moderate and advanced CKD, new phosphate lowering agent, phosphate targets, summary of hyperparathyroidism management and use of osteoporosis medications in CKD.