<p>Chronic kidney disease (CKD) is an independent risk factor for osteoporosis. Managing bone loss in CKD patients involves both non-pharmacological and pharmacological strategies. Romosozumab, a monoclonal antibody that targets sclerostin, represents a major advancement in osteoporosis treatment. Recent studies showed that the majority of patients with early stages of CKD tend to have low bone turnover. The dual romosozumab mechanism of suppressing bone resorption and augmenting bone formation could be helpful in those patients. However, the concerns about increasing vascular calcification need to be clarified. This review explores the effects of osteoporosis on CKD patients, detailing its pathogenesis especially the role of adynamic bone disease, shedding light on Wnt pathways and their influence on bone turnover and vascular calcifications. Lastly, we provide an in-depth overview of romosozumab and its effectiveness and reported safety in treating patients with CKD and osteoporosis.</p>