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373 In fact, when BMSCs are exposed to exendin-4, the expression of genes related to bone development factors such as Runx and Osterix, as well as genes responsible for producing the bone matrix such as Balp and Bglap, is upregulated

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Week 1-2: Starting Phase Community-reported starting doses begin around 0.5 mg weekly Bedtime injection self-reported to minimize nausea impact Reduced meal sizes (roughly 30-40%) commonly described Avoidance of high-fat foods for 24 hours post-injection Hydration with electrolytes commonly described Week 3-6: Early Adaptation Trial titration increased to 1 mg weekly when well-tolerated Side effects typically peaked during this period in trial data Protein-rich, easily digestible foods commonly described Anti-nausea medication reported under clinician guidance when needed Weight loss in trials clustered around 1-2 lbs/week Week 7-12: Stabilization Trial titration continued in gradual 1-2 mg increments Most GI side effects improved during this window in trial data Return to more normal eating patterns commonly described Gallbladder symptoms documented as weight loss accelerates Week 13+: Maintenance Trial subjects reached target dose based on response and tolerance Side effects were minimal at stable doses in trial data Sustainable lifestyle changes commonly described Regular monitoring of metabolic markers documented