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Renal osteodystrophy (RO) is a metabolic bone tissue condition causing significant morbidity in clients with ESRD, in particular fragility fractures. In this case series, we present the medical management of 3 ESRD patients with pathological fractures regarding the throat of femur (NOF) and medical procedures (parathyroidectomy) of tertiary hyperparathyroidism of ESRD clients in the same medical setting. Up-to-date there's been no reports on bipolar hemiar