TNF and vitamin D deficiency: Additionally, the associated effect of vitamin D deficiency, elevated TNF-α, and IL-6 with increased PLT activation and aggregation also plays a critical role in several aspects of osteoclastogenesis, enhancing the bone resorptive capacity via RANK/RANKL/OPG signaling, a system known for its roles in osteoclast maturation, as well as bone modeling and remodeling [122].