🙂 I also have indigestions from reading that article! The coupling concept has been discussed quite a bit in the literature - I added a citation mainly to prove I’m not making this stuff up, haha. As you pointed out, coupling is a very complex process involving overlapping mechanisms- biochemical (endocrine and paracrine), biomechanical, and cellular - and it’s certainly not one-way.

The TRIO study (Three Oral Bisphosphonate Therapies in Postmenopausal Osteoporosis) demonstrated an early decrease in the bone resorption marker CTX, followed by a subsequent decrease in the bone formation marker P1NP, as shown in the attached figures (alendronate data). That lagging pattern shows, indirectly but clearly, how resorption and formation remain linked, or “coupled", even under antiresorptive therapy.