As extant research mostly focused on the capacity of infliximab and adalimumab to induce changes in bone mineral density and the biochemical markers of bone resorption and synthesis, the aim of the present study was to evaluate the effectiveness of 12-month TNF-α inhibitor (etanercept, adalimumab, golimumab and infliximab) therapy in terms of bone metabolism improvements in patients with rheumatoid arthritis. Here, TNF is linked to rheumatoid arthritis.