The presence of osteopontin (OPN) at high levels in both mineralized tissues such as bone and ectopic calcifications such as atherosclerotic plaque presents a conundrum: is OPN a promoter or inhibitor of hydroxyapatite (HA) formation? In vitro studies show that OPN adsorbs tightly to HA and is a potent inhibitor of crystal growth. Although the mechanism of the OPN-HA interaction is not fully understood, it is probably electrostatic in nature. Phosphorylation enhances OPN's ability to adsorb to and inhibit the growth of HA crystals, although other anionic groups also contribute to these properties. Recent findings suggest that OPN is an intrinsically unordered protein and that its lack of folded structure facilitates the protein's adsorption by allowing multiple binding geometries and the sequential formation of ionic bonds with Ca(2+) ions of the crystal surface. By analogy with other biominerals, it is likely that adsorption of OPN to HA results in "pinning" of growth steps. The abundance of OPN at sites of ectopic calcification reflects upregulation of the protein in response to crystal formation or even in response to elevated phosphate levels. Therefore, it appears that OPN is one of a group of proteins that function to prevent crystal formation in soft tissues. The role of OPN in bone mineralization, if any, is less clear. However, it is possible that it modulates HA formation, either by preventing crystal growth in "inappropriate" areas such as the osteoid seam or by regulating crystal growth habit (size and shape).