Separate treatments may be needed for each of the four main causes of renal bone disease.

Patients on dialysis (either peritoneal dialysis or haemodialysis) obtain some extra calcium from the dialysis fluid. This happens because there is more calcium in the dialysis fluid than in the blood. Calcium passes from the stronger solution (the dialysis fluid) into the patient's blood (the weaker solution) by a process called diffusion.

If extra calcium from the dialysis fluid is not enough, patients are given calcium carbonate. This drug, also used to reduce blood phosphate levels, can raise the level of calcium in the blood.

Treatment with vitamin D can also raise calcium levels in the blood.

Though dialysis removes some phosphate from the blood, most renal patients need further treatment to control phosphate levels. Phosphate binders, such as calcium carbonate, need to be taken just before eating food to be effective.

The target blood phosphate level is less than 1.8 mmol/L for a patient on dialysis.

Vitamin D treatment is also needed to prevent renal bone disease. The most common form of treatment is with alfacalcidol, which provides the active vitamin D that is lacking and increases blood calcium levels. Peritoneal dialysis patients receive vitamin D in the form of a pill. Haemodialysis patients receive it either as a pill or as an injection during dialysis.

The target blood calcium level for dialysis patients is between 2.2 to 2.6 mmol/L.

In most patients, correcting the blood levels of calcium, phosphate and vitamin D is enough to control renal bone disease, and to cause PTH levels to fall.

In some patients, the levels of PTH in the blood continue to rise. When this happens the blood calcium tends to rise to above normal (it is usually low in kidney failure), and the blood phosphate is very high. Dialysis and drugs cannot treat this combination of an extremely high PTH, a high calcium level, and a very high phosphate level. It may be necessary to carry out an operation to remove the parathyroid glands. This operation is called a parathyroidectomy.