Is rationale to decrease serum osteoprotegerin and fetuin-A in type 2 diabetes mellitus patients?

Fetuin-A and osteoprotegerin (OPG) are considered biomarkers of atherosclerosis, vascular calcification, inflammation in subjects with type 2 diabetes mellitus (T2DM) with possible predictive value. Recent clinical studies have been shown that fetuin-A and OPG could be helpful for cardiovascular risk stratification in T2DM. Therefore, fetuin-A and OPG may offer protection against atherosclerosis and vascular calcification. However, clinical implication of decreased serum concentrations of these biomarkers in T2DM during treatment with thiazolidinediones, in particular pioglitazone, and metformin is not fully understood. The relation of thiazolidinediones- and metformin- induced post-treatment serum levels of fetuin-A and OPG to changes in CV risk requires more investigations.