Patients with chronic kidney disease have poor bone strength and increased fracture risk. Hip fractures, which tend to be debilitating, are particularly common and can result in an increased risk of death. My primary interest is the effect of kidney disease on the skeleton, with an emphasis on the microstructural and biochemical mechanisms by which kidney failure increases fracture risk. The identification of these mechanisms will lay the groundwork for the development and study of novel and effective fracture prevention strategies. After kidney transplantation fracture risk is markedly increased, particularly of the spine and hip. We are currently studying risk factors for and the structural, microarchitectural and biochemical mechanisms of fracture after kidney transplantation. These data will advance the development of novel fracture prevention strategies for kidney transplant recipients.