TNF and osteoporosis: Locally increased production of cytokines such as kappa β-ligand (RANKL), tumor necrosis factor(TNF-α), IL-6, and IL-1β by immune cells and osteoclasts in periodontitis can accelerate systemic bone resorption.[15] Many researchers have proposed menopause as a risk factor for osteoporosis which is related to reduced estrogen, as morecomorbidities seen in this study were found in female periodontitis patients.