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This is a known concern with GLP-1 medications, and tirzepatide and bone loss is an active area of research

Cell 169 , 286300.e16 (2017)

Haghikia A, Li XS, Liman TG, Bledau N, Schmidt D, Zimmermann F, et al

According to FDA prescribing information, gastrointestinal side effects are typically most pronounced during dose initiation and escalation, and they often diminish over time as the body adapts to the medication

(R)-(3-Carboxy-2-hydroxypropyl)-trimethyl ammonium Fumarate CAS 90471-79-7 Chemical Formula C11H19NO7 Molecular Weight 277.3 g/mol L-carnitine fumarate is a compound that combines L-carnitine, a naturally occurring substance involved in the metabolism of fats, with fumaric acid, an intermediate in the Krebs cycle (which helps generate energy in the body)