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The low bone turnover observed in a significant proportion of patients in early stages of CKD could be due to the initial predominance of bone turnover inhibitory conditions such as resistance to the action of PTH, reduced serum calcitriol levels, sex hormone deficiency, diabetes, inflammation and malnutrition, and uremic toxins leading to the repression of osteocyte Wnt--catenin signaling and increased expression of Wnt antagonists such as sclerostin, Dickkopf-1 and secreted frizzled-related protein 4 (7,8)

There are two studies [8,60] that compare tirzepatide and semaglutide and are relevant to our study

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