This study investigated the effect of different severities of CKD on femoral neck bone mineral density (BMD) in patients treated with denosumab. This study was a retrospective case review of CKD patients treated with denosumab. Baseline age, sex, and body mass index (BMI) were recorded for all patients. All comorbidities such as diabetes, hypertension, liver, and estimated glomerular filtration rate (eGFR) serum collagen type 1 cross-linked C-telopeptide (CTX) were also recorded. All subjects underwent dual energy X-ray absorptiometry assay of the femoral neck to determine the BMD. Changes in femoral neck BMD between baseline and 1 year after denosumab administration were recorded. A total 108 patients with CKD who had received denosumab therapy were enrolled. The mean age was 71.04 +/- 9.64 years, and 96 patients (88.9 %) were women. Baseline eGFR correlated negatively with changes in the BMD of femoral neck (Rho =40.6, P < 0.01). The lower the eGFR, the more was the improvement in BMD in the femoral neck after denosumab therapy. When changes in femoral neck BMD were assessed as outcome measures using linear regression, young patients (P = 0.001) and those with a low eGFR benefitted more from denosumab therapy (P = 0.029). Denosumab therapy is effective in cases of low eGFR and young age. Aggressive medical attention is needed in these patients.