Abnormalities in bone and mineral metabolism begin to develop in the early stage of CKD. Serum phosphorus, calcium, PTH, and alkaline phosphatase are recommended to be measured from CKD stage 3, and it is suggested that these markers are maintained within the reference ranges of each facility. The management of phosphorus is essential and is composed of phosphorus restriction and phosphate binders. Small amount of VDRA suppresses PTH for secondary hyperparathyroidism and is expected to reduce mortality and proteinuria. The effects of the intervention to reduce the phosphorus load before hyperphosphatemia is manifested need to be investigated.