TNF and rheumatoid arthritis: On the other hand, the use of TNF inhibitors has been shown to affect bone metabolism by increasing the P1NP and osteocalcin (OC) serum level (as bone synthesis markers), and decreasing the levels of serum b-CTX and RANKL (as bone resorption markers in RA), thus slowing down generalized osteoporosis and the development of periarticular erosions [31].