TNFSF11 and heart failure: They also found that the β2-AR agonist terbutaline directly inhibits bone formation by impairing osteogenic differentiation and mineralization.88 Sui et al. reported that β2AR agonists release RANKL through osteoblasts, activate the downstream signal of osteoclast β2AR, and significantly promote bone resorption by upregulating osteoclast miR-21.89 Studies have shown that β-AR upregulation drives bone resorption by enhancing RANKL signaling, but the downregulation of α-AR leads to the loss of sympathetic nerve inhibition function, which together aggravates heart failure-related bone loss.86