The authors state that long-term inflammation in COPD mediates the effects of NF-κB, RANKL (Receptor Activator of Nuclear Factor-kappa B Ligand), and M-CSF (Macrophage Colony-Stimulating Factor), while hypoxic damage activates the UPS system. Additionally, long-term hormone therapy leading to decreased IGF-1 levels plays a key role in the development of osteosarcopenia. Here, TNFSF11 is linked to chronic obstructive pulmonary disease.