Changes of the inflammatory cytokines TNF-α and IL-6 can induce enhanced osteoclast function through the OPG/RANK/RANKL signaling pathway and may be critical for changes in bone microstructure and BMD during the “second hit” phase of NAFLD (at 24 weeks). The gene discussed is TNFRSF11B; the disease is metabolic dysfunction-associated steatotic liver disease.