TNF and medical procedure: Although PTHrpis the mediator most often identified, other mediators may be involved, includinginterleukin (IL)-1, IL-6, tumor necrosis factor (TNF-α), transformation growthfactor beta (TGF-β), prostaglandins, calcitriol, and PTH that is producedectopically.(6) In addition,the medium- and long-term adverse effects of bisphosphonates have been associated withosteonecrosis of the jaw and ectopic deposition of calcium.(7) However, to date, no adverse effects related tobisphosphonates have been observed in the described case.