Emerging effects of DPP-4 on bone metabolism include an inverse relationship between DPP-4 activity levels and bone mineral density, along with an increased risk of fractures
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and 1.4% versus 2.8% died from any cause (HR 0.51, 95% CI 0.310.84), all treated with oral semaglutide or placebo, respectively [44]
Two non-canonical D-isomer residues (D-2-naphthylalanine at position 3 and D-phenylalanine at position 4) plus C-terminal amidation distinguish the pentapeptide from proteinogenic precursors