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Biol Psychiatry (2010) 67(9):8806

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This process generates gut-derived uremic toxins, including p-cresyl sulfate, indoxyl sulfate, and trimethylamine N-oxide (TMAO) (254), which impair osteoblast differentiation, suppress bone formation, and reduce bone mineral density (255257)

Each pathway is regulated by various factors (eg, stem cell factor, thrombopoietin, various interleukins, erythropoietin, etc), and key specific transcription factors (not indicated in the figure) are also involved at the stages indicated