Association of bone biomarkers with advanced atherosclerotic disease in people with overweight/obesity

Endocrine. 2021 Aug;73(2):339-346. doi: 10.1007/s12020-021-02736-8. Epub 2021 May 4.


Background: A growing body of evidence suggests a potential link between bone metabolism and cardiovascular disease. Aim of this study was to investigate the relationship between levels of circulating bone turnover biomarkers and advanced atherosclerosis.

Methods: Klotho (KL), sclerostin (SOST), osteopontin (OPN) and osteoprotegerin (OPG) were measured in patients undergoing elective coronary angiography and carotid Doppler ultrasound. The primary outcome was the difference in bone biomarkers levels between participants with and without advanced atherosclerosis, defined as the presence of a critical coronary (≥70%) and/or carotid (≥50%) stenosis.

Results: A total of 80 subjects (32.5% females) with a mean age of 68 ± 10 years were included. Advanced atherosclerosis was detected in 55 (68.8%) patients. Subjects with advanced atherosclerosis showed higher serum levels of OPG (p = 0.0015) and SOST (p = 0.017) and similar levels of KL (p = 0.62) and OPN (p = 0.06) compared to patients without. After adjustment for age and sex, only elevated levels of OPG remained significantly associated with advanced atherosclerosis (p = 0.011).

Conclusions: Higher serum levels of OPG are independently associated with advanced atherosclerosis confirming a common bond between bone metabolism and vascular disease. Further investigations on the role of selected bone biomarkers in the pathogenesis of cardiovascular disease are needed.

Keywords: Atherosclerosis; Bone biomarkers; Bone-vascular axis; Cardiovascular disease.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adaptor Proteins, Signal Transducing / blood
  • Aged
  • Atherosclerosis* / diagnostic imaging
  • Biomarkers
  • Female
  • Glucuronidase / blood
  • Humans
  • Klotho Proteins
  • Male
  • Middle Aged
  • Obesity
  • Osteopontin / blood
  • Osteoprotegerin* / blood
  • Overweight


  • Adaptor Proteins, Signal Transducing
  • Biomarkers
  • Osteoprotegerin
  • SOST protein, human
  • Osteopontin
  • Glucuronidase
  • Klotho Proteins