Although vascular calcification is present in the vast majority of those aged over 70 years and causes serious cardiovascular dysfunction, strategies for its prevention and effective management are currently not available because the mechanism of its pathogenesis is unknown. Recently, similarities between mineralization in the vessel wall and in bone have been recognized. In this review, current understanding of the mechanisms involved in atherosclerotic calcification is summarized. In addition, several observations that may explain the paradox of vascular calcification in the face of osteoporosis are noted, emphasizing the possible role of lipid oxidation products.