IMPAIRED OSTEOGENESIS AS A LINK IN THE CHAIN OF ATHEROSCLEROSIS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS: PATHWAYS TO OVERCOMING IT

Alla V. Kovalchuk; Olesia V. Zinych; Nataliia M. Kushnareva; Volodymyr M. Kovalchuk; Olha V. Prybyla; Kateryna O. Shyshkan-Shyshova

doi:10.31435/ws.1(91).2026.4915

Alla V. Kovalchuk MD, PhD, Leading Researcher of the Department of Age Endocrinology and Clinical Pharmacology, State Institution "V.P. Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine", Kyiv, Ukraine https://orcid.org/0000-0001-6591-1460
Olesia V. Zinych Dr. habil., Head of the Department of Age Endocrinology and Clinical Pharmacology, State Institution "V.P. Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine", Kyiv, Ukraine https://orcid.org/0000-0002-0516-0148
Nataliia M. Kushnareva MD, PhD, Senior Researcher of the Department of Age Endocrinology and Clinical Pharmacology, State Institution "V.P. Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine", Kyiv, Ukraine https://orcid.org/0000-0002-5390-6784
Volodymyr M. Kovalchuk MD, PhD, Assistant Professor of the Department of Orthopedics and Traumatology, Shupyk National University of Healthcare of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0003-2363-7365
Olha V. Prybyla MD, PhD, Junior Researcher of the Department of Age Endocrinology and Clinical Pharmacology, State Institution "V.P. Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine", Kyiv, Ukraine https://orcid.org/0000-0003-2212-1172
Kateryna O. Shyshkan-Shyshova MD, Junior Researcher of the Department of Age Endocrinology and Clinical Pharmacology, State Institution "V.P. Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine", Kyiv, Ukraine https://orcid.org/0000-0003-0939-5902

DOI: https://doi.org/10.31435/ws.1(91).2026.4915

Keywords: Diabetes, Osteocalcin, Osteogenesis, Cardiovascular Disease, Glucagon-Like Peptide-1 Receptor Agonist (GLP-1 RA), Sodium-Glucose Cotransporter-2 Inhibitor (SGLT2i)

Abstract

Cardiovascular diseases in patients with type 2 diabetes mellitus exhibit a more aggressive course compared to those without this metabolic disorder. Concurrently, shared mechanisms exist between bone tissue development and atherosclerotic arterial calcification. The aim of this study was to establish potential associations between osteocalcin levels and cardiovascular complications in patients with type 2 diabetes mellitus, as well as the impact of additional glucose-lowering therapy using glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is). Methods. A total of 99 patients with type 2 diabetes mellitus were examined, including 62 men and 37 women. The mean age of the participants was 59.18 ± 1.32 years (range: 46 to 67 years). Patients had no documented history of severe cardiovascular complications, such as myocardial infarction, stroke, or stenting/bypass of coronary, carotid, or peripheral arteries. Among them, 34 patients received GLP-1 RAs in addition to baseline therapy with metformin and sulfonylurea derivatives for one year, while 25 received SGLT2is. Osteocalcin levels were measured, and echocardiographic examinations were performed. Results. Low serum osteocalcin levels were associated with the development of diastolic dysfunction characterized by impaired relaxation, left ventricular hypertrophy, and atherosclerotic aortic wall involvement in patients without clinical signs of cardiovascular disease. This was not observed in patients with type 2 diabetes mellitus who had higher osteocalcin levels. Additional use of GLP-1 RAs with baseline glucose-lowering therapy significantly increased blood osteocalcin levels. Additional use of SGLT2is did not demonstrate changes in osteocalcin levels. Conclusion. Low serum osteocalcin levels in patients with type 2 diabetes mellitus may be considered a marker for future severe cardiovascular diseases. Additional use of GLP-1 RAs with baseline glucose-lowering therapy increases blood osteocalcin levels, indicating a positive impact on the cardiovascular system.

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