CKD-MBD is systemic disorder that contains mineral and hormonal disorders, vascular calcification, and renal osteodystrophy. Renal osteodystrophy induces the deterioration of bone strenth in the aspect of bone quantity measured by BMD and bone quality such as bone microarchiecture, mineralization, and bone turnover.    CKD patients have 2-4 times greater risk of fractures compared with general populartion. For CKD progression, the risk of fracture and the proportion of hip fracture are increased.    To evaluate the risk of fracture in CKD patients, serum biomarker such as bone specific alkaline phosphatase and iPTH, skeletal imaging such as DEXA and HRqCT, and FRAX tool can be used. 2017 KDIGO guideline recommend BMD testing to assess fracture risk in patients with CKD G3a-G5D with evidence of CKD-MBD and/or risk factors for osteoporosis.   To decrease the risk of fracture in CKD patients, lifestyle interventions and CKD-MBD management are necessary. In the CKD patients with CKD-MBD and/or clinical risk factors for fracture, BMD should be performed. If T-score< -2.5 and with clinical history of fracture, bone turnover should be assessed. In high bone turnover disease, anti resorptive agents are used and in low bone turnover disease, anabolic agents are used.    The further evaluation for treatment of osteoporosis in CKD patients are needed.