TNFRSF11A and amenorrhea: Furthermore, by observing bone histomorphometry in MHD patients, Barreto et al. demonstrated that independent determinants of osteoporosis determined by trabecular bone volume (BV/TV) were the sRANKL/OPG ratio and length of amenorrhea, which indicated bone loss through the OPG/OPG ligand/RANK signal pathway [17].