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Loss of muscle mass is a key driver of bone density decline, as it reduces the dynamic strain on the skeleton, thereby accelerating disuse signaling

OS also reduces tetrahydrobiopterin (BH4), a critical cofactor for eNOS, causing it to produce more ROS instead of NO, thereby amplifying endothelial injury (Figure 2), such as BH4 supplementation, NOX inhibitors, and lifestyle modifications (e.g., exercise, Mediterranean diet), aim to restore redox balance and endothelial function, though their efficacy varies by HTN stage and comorbidities

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