Skeletal cells control the initiation of mineralization in vivo and determine the selective distribution pattern of mineralization by releasing calcification-initiating, submicroscopic, extracellular matrix vesicles (MVs) at selected sites in the extracellular matrix. The overall objective of this review is to outline what is currently known about the mechanisms of MV biogenesis and mineral initiation, while emphasizing recent observations that enhance our understanding of these mechanisms. Data from studies on the general mechanism of biogenesis of outer membrane vesicles and the formation and function of non-skeletal matrix vesicles is presented to stimulate thought concerning the possible biological functions that these structures may share with MVs.