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The effects of DPP-4 on bone health are underscored by its effects in generating proinflammatory cytokines such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-), contributing to inflammatory processes mediated by adipose tissue macrophages, which are implicated in conditions ranging from obesity to osteoporosis [21]

Communication refers to the gut-brain axis

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"GLP-1 Diet: Foods to Eat and Avoid on Weight Loss Medication." March 2025

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Once the adipose tissue expandability exceeded limit under overnutrition, excess lipids and toxic lipid metabolites (FFA, diacylglycerol, ceramide) accumulated in non-adipose tissues, thus leading to lipid-induced toxicity (lipotoxicity) and developed IR in liver and muscle