Aim To study the relationship between the serum osteoprotegerin(OPG) levels and macrovascular complications in type 2 diabetes. Methods 88 type 2 diabetes were divided into macrovascular complications group and no macrovascular complications group.The clinical and biochemical data of all subjects were recorded and fasting serum OPG levels were measured with enzyme-linked immunosorbent assay(ELISA). Results The serum OPG level in type 2 diabetes with macrovascular complications was 4.12±0.64 ng/L,which was significantly higher than that of no macrovascular complications group(2.78±0.59 ng/L) and control group(2.29±0.37 ng/L,P<0.01).The serum OPG level in type 2 diabetes was positively correlated with fasting plasma glucose(FPG),2 h plasma glucose(2hPG),glycosylated hemoglobin A1c(HbA1c),homeostasis model assessment of insulin resistance(HOMA-IR) and high sensitive C reactive protein(hs-CRP)(P<0.05).The Logistic regression analysis showed the macrovascular complications in type 2 diabetes had significant correlation with serum OPG,FPG and hs-CRP. Conclusions The correlation between higher serum OPG level and macrovascular complications in type 2 diabetes suggests OPG may play an important role in the pathogenesis of macrovascular complications.