diff --git a/monai/losses/cldice.py b/monai/losses/cldice.py
index 7d7e447c54..ab580d0160 100644
--- a/monai/losses/cldice.py
+++ b/monai/losses/cldice.py
@@ -20,9 +20,11 @@
 
 from monai.losses.dice import DiceLoss
 from monai.networks import one_hot
-from monai.utils import LossReduction
+from monai.utils import LossReduction, optional_import
 from monai.utils.deprecate_utils import deprecated_arg
 
+binary_thinning_3d, _has_thinning = optional_import("binary_thinning_3d")
+
 
 def soft_erode(img: torch.Tensor) -> torch.Tensor:  # type: ignore
     """
@@ -129,6 +131,7 @@ def __init__(
         softmax: bool = False,
         other_act: Callable | None = None,
         reduction: LossReduction | str = LossReduction.MEAN,
+        use_hard_target: bool = False,
     ) -> None:
         """
         Args:
@@ -151,6 +154,8 @@ def __init__(
                 - ``"none"``: no reduction will be applied.
                 - ``"mean"``: the sum of the output will be divided by the number of elements in the output.
                 - ``"sum"``: the output will be summed.
+            use_hard_target: if True, use the exact CUDA 3D binary thinning for the target skeleton instead of soft skeletonization.
+                Requires binary_thinning_3d_cuda package and a CUDA 3D target. Defaults to False.
 
         Raises:
             TypeError: When ``other_act`` is not an ``Optional[Callable]``.
@@ -181,6 +186,7 @@ def __init__(
         self.sigmoid = sigmoid
         self.softmax = softmax
         self.other_act = other_act
+        self.use_hard_target = use_hard_target
 
     @deprecated_arg("y_pred", since="1.5", removed="1.8", new_name="input", msg_suffix="please use `input` instead.")
     @deprecated_arg("y_true", since="1.5", removed="1.8", new_name="target", msg_suffix="please use `target` instead.")
@@ -226,7 +232,19 @@ def forward(self, input: torch.Tensor, target: torch.Tensor) -> torch.Tensor:
             raise AssertionError(f"ground truth has different shape ({target.shape}) from input ({input.shape})")
 
         skel_pred = soft_skel(input, self.iter)
-        skel_true = soft_skel(target, self.iter)
+        if self.use_hard_target:
+            if not (target.dim() == 5 and _has_thinning and target.is_cuda):
+                raise ValueError(
+                    "use_hard_target=True but conditions not met. "
+                    "Requires 5D CUDA tensor and binary_thinning_3d_cuda package."
+                )
+            skel_true = (target > 0).to(torch.uint8).contiguous()
+            for b in range(target.shape[0]):
+                for c in range(target.shape[1]):
+                    binary_thinning_3d.binary_thinning(skel_true[b, c], 0)
+            skel_true = skel_true.to(target.dtype)
+        else:
+            skel_true = soft_skel(target, self.iter)
 
         # Compute per-batch clDice by reducing over channel and spatial dimensions
         # reduce_axis includes all dimensions except batch (dim 0)
@@ -279,6 +297,7 @@ def __init__(
         softmax: bool = False,
         other_act: Callable | None = None,
         reduction: LossReduction | str = LossReduction.MEAN,
+        use_hard_target: bool = False,
     ) -> None:
         """
         Args:
@@ -304,6 +323,8 @@ def __init__(
                 - ``"none"``: no reduction will be applied.
                 - ``"mean"``: the sum of the output will be divided by the number of elements in the output.
                 - ``"sum"``: the output will be summed.
+            use_hard_target: if True, use the exact CUDA 3D binary thinning for the target skeleton instead of soft skeletonization.
+                Requires MONAI C++ extensions and a 3D target. Defaults to False.
 
         Raises:
             TypeError: When ``other_act`` is not an ``Optional[Callable]``.
@@ -336,6 +357,7 @@ def __init__(
             softmax=softmax,
             other_act=other_act,
             reduction=reduction,
+            use_hard_target=use_hard_target,
         )
         self.alpha = alpha
         self.to_onehot_y = to_onehot_y
diff --git a/setup.cfg b/setup.cfg
index d987141d0b..db4bd22fd4 100644
--- a/setup.cfg
+++ b/setup.cfg
@@ -90,6 +90,7 @@ all =
     nvidia-ml-py
     huggingface_hub
     pyamg>=5.0.0, <5.3.0
+    binary_thinning_3d_cuda
 nibabel =
     nibabel
 ninja =
@@ -179,6 +180,8 @@ huggingface_hub =
     huggingface_hub
 pyamg =
     pyamg>=5.0.0, <5.3.0
+binary_thinning =
+    binary_thinning_3d_cuda
 # segment-anything =
 #     segment-anything @ git+https://github.com/facebookresearch/segment-anything@6fdee8f2727f4506cfbbe553e23b895e27956588#egg=segment-anything
 
diff --git a/tests/losses/test_cldice_loss.py b/tests/losses/test_cldice_loss.py
index cb17cb81ad..71a036109b 100644
--- a/tests/losses/test_cldice_loss.py
+++ b/tests/losses/test_cldice_loss.py
@@ -85,6 +85,19 @@ def test_cuda(self):
         result = loss(ONES_2D["input"].cuda(), ONES_2D["target"].cuda())
         np.testing.assert_allclose(result.detach().cpu().numpy(), 0.0, atol=1e-4)
 
+    @skip_if_no_cuda
+    def test_hard_target(self):
+        """Test SoftclDiceLoss with use_hard_target=True using binary thinning on 3D CUDA tensors."""
+        # Skip if binary_thinning not available
+        from monai.losses.cldice import _has_thinning
+        if not _has_thinning:
+            self.skipTest("binary_thinning_3d_cuda not available")
+
+        loss = SoftclDiceLoss(use_hard_target=True)
+        # MUST BE 3D for hard target logic to trigger! (shape: B, N, H, W, D)
+        result = loss(ONES_3D["input"].cuda(), ONES_3D["target"].cuda())
+        np.testing.assert_allclose(result.detach().cpu().numpy(), 0.0, atol=1e-4)
+
     def test_reduction_shapes(self):
         input_tensor = torch.ones((4, 2, 8, 8))
         target = torch.ones((4, 2, 8, 8))