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The widespread use of DPP-4 inhibitors among patients with T2DM and advanced age, who are more predisposed to osteoporosis, underscores the need for a better understanding of the relationship between DPP-4 enzyme activity, its substrates, pharmacological inhibition, and bone metabolism

Importantly, proteolytic cleavage of SPARC (secreted protein acidic and rich in cysteine), a matricellular protein abundantly expressed at sites of vascular injury and tissue remodeling, generates GHK-containing fragments that promote endothelial cell proliferation and neovascularization

For tirzepatide (currently on 15 mg weekly): Weeks 1-2: Step down to 10 mg weekly

Sarcopenia is also age-associated but may be exacerbated by obesity, leading to higher disability, frailty, morbidity and mortality rates [171]