It is well recognized that TNF-α induces differentiation of osteoclast precursors through synergistic action with RANKL.[16] Shin et al did not find a significant difference in the risk of fracture between TNF initiators and abatacept or tocilizumab among RA patients.[17] Our data showed no significant differences among the different bDMARDs in the incidence of vertebral fracture in RA patients. Here, TNF is linked to rheumatoid arthritis.