The initial treatment of choice for secondary hyperparathyroidism in renal osteodystrophy is:

Answer is D (Phosphate Binders) The initial treatment of secondary hyperparathyroidism in renal osteodystrophy is management of high phosphate levels by dietary restriction and the use of Phosphate binders The objectives of management are to maintain blood levels of calcium and phosphorous to as close to normal as possible, to prevent or treat established hyperparathyroidism early and to prevent parathyroid hyperplasia. Phosphate retention begins early in the course of CKD, perhaps as early as in stage 2 and paicipates in the development of secondary hyperparathyroidism. Central to the management of high-turnover bone disease is controlling the serum phosphate levels. This may be achieved by dietary phosphate restriction or by the use of phosphate binders. Phosphate-binder therapy is recommended when serum phosphate concentrations are elevated despite patient compliance with dietary phosphate restriction. Calcium-based phosphate binders are often recommended as the initial binder therapy. High Bone Turnover Disease Bone turnover (the formation and removal of bone) is increased due to a process called secondary hyperparathyroidism (SHPT). Secondary hyperparathyroidism represents a common disorder in patients with CKD. It develops as a result of hyperphosphatemia, hypocalcemia and impaired renal vitamin D synthesis with reduction in serum calcitriol levels