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Multiple randomized controlled trials and meta-analyses in patients with type 2 diabetes and obesity demonstrate that GLP-1RA therapy either preserves or modestly increases bone mineral density (BMD) at key skeletal sites lumbar spine and hip, GLP-1RAs also favorably modulate bone turnover markers, increasing bone formation markers (P1NP, osteocalcin, bone-specific alkaline phosphatase) and reducing bone resorption markers (-CTX), suggesting a net positive or neutral effect on bone remodeling