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calcium supplementation only if dietary intake is inadequate) [4] Nutritional assessment to ensure adequate protein intake during weight loss (minimum 1.0-1.2g/kg body weight) Encouragement of weight-bearing exercise and resistance training to maintain bone strength, in line with UK Chief Medical Officers' Physical Activity Guidelines Medication review to identify and address other factors affecting bone health Repeat fracture risk assessment in high-risk patients, with DXA scanning as clinically indicated based on NICE/NOGG guidance Patients experiencing weight loss faster than planned (particularly if exceeding 0.5-1kg per week sustained over several weeks) should be reviewed to ensure nutritional adequacy and consider whether treatment adjustment is appropriate

The most common concomitant therapies were insulin (66%), SGLT2 inhibitors (60%), and biguanides (48%)

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Referral to specialists should be considered when patients have persistent A1C elevations despite combination therapy, complex obesity requiring specialized care, or when evaluating bariatric surgery options (typically for BMI 40 kg/m or 35 kg/m with comorbidities)

Aim for two portions of fish per week