Although many established biomarkers associated with insulin resistance act via systemic and local pro- inflammatory and catabolic mechanisms, including leptin and its association with bone formation biomarkers osteocalcin and PINP, TLR4, visfatin, PLA2G2A, metrnl, adipolin, and resistin, more investigation is required into the impact of treatment on these biomarkers in MetS-OA. This evidence concerns the gene TLR4 and metabolic syndrome.