Gut-targeted interventions to complement PTH-lowering therapy.

Secondary hyperparathyroidism is a major contributor to skeletal fragility in chronic kidney disease, yet fracture risk remains high despite parathyroid hormone-lowering therapy. In a rat model of chronic kidney disease, Allen et al. showed that combining the prebiotic fiber inulin with a calcimimetic further suppresses elevated bone turnover while improving cortical bone architecture and mechanical properties. These findings highlight the potential of gut-targeted interventions to complement established parathyroid hormone-lowering strategies for improving skeletal health.