Vascular calcification is highly prevalent in patients with coronary artery disease and, when present, is associated with major adverse cardiovascular events, including an increased risk of cardiovascular mortality. The pathogenesis of vascular calcification is complex and is now recognized to recapitulate skeletal bone formation. Vascular smooth muscle cells (SMC) play an integral role in this process by undergoing transdifferentiation to osteoblast-like cells, disrupting calcium and phosphate homeostasis, diminishing the activity of osteoclast-like cells with mineral resorbing capacity. Recent advances have identified microRNA (miRNA) as key regulators of this process by directing the complex genetic reprogramming of SMC and the functional responses of other relevant cell types relevant for vascular calcification. This review will detail the regulatory role of miRNA in SMC-mediated vascular calcification.