TNF and Insulin resistance: As discussed above, sarcopenia and osteoporosis share common risk factors and underlying pathophysiological mechanisms, including insulin resistance, decreased anabolic hormones, such as IGF-1 and testosterone, and upregulated inflammatory cytokines such as IL-1, IL-6, and TNF-α, which may contribute to the development of osteosarcopenia in liver disease, although their involvement has rarely been proven in osteosarcopenia models.