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Subchondral bone is an essential component of the joint, and the subchondral bone remodeling dominated by osteoclasts and osteoblasts can reflect the OA process [91, 92]

A consultation is required prior to starting any protocol

What missing therapies would you add here that are commonly used in your practice

The tesamorelin + ipamorelin blend works by creating a coordinated signal cascade: tesamorelin binds to GHRH receptors in the anterior pituitary, triggering endogenous GH synthesis and release, while ipamorelin simultaneously binds to ghrelin receptors (specifically the GHS-R1a subtype), amplifying that GH pulse without elevating cortisol or prolactin