Table 1.

Paradigm shift in mineral and bone metabolism in the past 10 yra

PreviousPresent
Push PTH as low as possible!Well, not that low, and assays are not perfect
Give as much activated vitamin D as possibleWell, not that much (and change vitamin D type)
Give lots of calcium to suppress PTHToo much calcium can cause calcium overload and vascular calcification
A phosphorus of 7 and calcium × phosphorus of 70 is okayBut that can cause vascular calcification and is associated with mortality
25(OH)-vitamin D is not importantDeficiency is common
  • a PTH, parathyroid hormone.