The risk of bone fracture is increased in patients with chronic kidney disease (CKD), but current treatments to reduce fractures might be associated with an increased risk of arterial calcification. Both calcium and zoledronic acid treatment, alone or in combination, improved bone volume and suppressed bone remodelling in a rat model of CKD. Improvements in the biomechanical properties of bone and a reduced parathyroid hormone level were seen with calcium treatment alone, but at increased risk of extra-skeletal calcification.