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The therapeutic era of peptides began in 1921 with the discovery of insulin, a breakthrough that revolutionized diabetes and helped establish biologic therapies in medicine 1 Since then, peptide hormones like oxytocin and human growth hormone (GH) have entered clinical use, and glucagon-like peptide-1 (GLP-1) receptor agonists such as semaglutide are now widely prescribed for obesity and metabolic diseaseconditions increasingly recognized for their effect on orthopaedic outcomes

The propeptides are cleaved by endopeptidases after secretion into the extracellular space (extracellular activation) or before they are incorporated into storage vesicles (intracellular activation) [21, 22]

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Certain symptoms require escalation , including severe or worsening pain, progressive weakness, or changes in bowel or bladder function