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You have never had your bone status checked You are in one of these higherrisk groups and have never had a DEXA scan or a real conversation about bone risk You plan to start or stay on tirzepatide for the long haul without any baseline bone data to compare against If you see yourself in several of these buckets, you need a bonefirst plan on tirzepatide: baseline DEXA, targeted labs, and a clear musclepreserving strategy baked into your protocol from day one

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