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Other contributors may include mast-cell activation, allergy, chronic inflammation, medication effects or reduced intracellular breakdown by HNMT

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The anti-resorptive medication denosumab (Prolia), although not a bisphosphonate, is included in this category because it also targets osteoclast activity through a different mechanism

Clinical Logic: In such cases, GLP-1 therapy should be introduced early as an adjunct to LSM rather than a last-resort measure