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Overdosing increases side effects and potentially creates safety concerns

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]

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Animal studies have raised concerns including smaller fetuses, delayed bone development, skeletal changes and pregnancy loss, especially when mothers lose a significant amount of weight during early fetal development