. All the BMD measurements were done by the same experienced operator. We used the World Health Organization criteria for osteoporosis. Standardized spinal X-rays were taken for morphometric analysis of all participants of the study and they were interpreted according to the algorithm developed by McCloskey and colleagues. Carotid intima-media thickness Ultrasonographic examination of the carotid arteries was performed with patients in supine position using Doppler ultrasonography.In contrast, we did not found a significant relationship with bone remodelling markers osteoporosis diagnosis or morphometric vertebral fractures, in the total sample or in the study groups separately. Discussion To our knowledge, there is no previous study evaluating DKK1 concentrations and its relationship with CVD in Caucasian T2DM patients. There is also scarce data concerning the relationship between DKK1 and bone metabolism in T2DM. Our results show that higher levels of DKK1 are associated with clinical CVD and abnormal IMT in T2DM patients. These findings suggest that serum DKK1 are related to the presence of CVD in this population. However, our data showed no differences in serum DKK1 between T2DM patients and non-diabetic patients. Regarding bone metabolism, we found a significant relationship with bone mineral density. In our study, higher DKK1 levels were positively related to cardioMedChemExpress Piceatannol vascular disease in T2DM patients independently of the presence of others risk factors for atherosclerosis, and high concentrations of DKK1 were related to abnormal IMT in these patients. Our results are in accordance with previous reports showing the relationship between vascular disease and DKK1 in other populations. Patients with cerebrovascular disease have higher serum DKK1 levels compared with control subjects, and serum DKK1 correlated with coronary artery calcification and atherosclerotic plaques evaluated by coronary computed tomography and coronary artery calcium scoring. Previously, Ueland and colleagues demonstrated that DKK1 expression 
is enhanced in advanced carotid plaques and that DKK1 is a novel mediator in platelet-mediated endothelial cell activation, which could occur PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/19692133 within the atherosclerotic lesions. Moreover, current data clearly demonstrate a novel role for Wnt proteins in the proliferation, migration, and survival of smooth muscle cells . Regarding this, higher levels of DKK1 are present in advanced carotid plaques and DKK1 promotes platelet-mediated activation of endothelial cells. Thus, it has been proposed that this could lead to enhanced inflammation in the atherosclerotic lesion; however, it may also lead to a reduced survival, proliferation, and migration of SMCs, thereby reinforcing the potential complexity of the participation of Wnt proteins in atherosclerosis. In contrast to our findings, DKK1 concentrations were negatively associated with atherosclerotic calcified plaque in African-Americans patients with T2DM. There are several reasons that might contribute to this discrepancy. As the authors point, AAs have lower rates of vascular calcification. It has DKK1 and Cardiovascular Disease in Type 2 Diabetes been reported lower levels of coronary artery calcified plaque relative to European Americans despite similar or more detrimental cardiovascular risk factor profiles. This observation is consistent both in T2DM and subjects without diabetes, and suggests a PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/19690573 differential impact of CV risk factors on atherosclerosis based on ethnicity a