Fetuin-A, a glycoprotein primarily produced by the liver, plays a crucial role in regulating calcium and phosphate metabolism. Genetic polymorphisms in the Fetuin-A gene have been linked to alterations in its expression and function, potentially contributing to cardiovascular disease by influencing vascular calcification and impacting bone mineral density. Understanding these genetic variations can provide insights into shared pathways between cardiovascular and skeletal health, paving the way for targeted therapeutic strategies. Aim: To asses possible correlation between Fetuin-A levels with cardiovascular disease risk and bone mineral density among diabetic nephropathy patients compared to controls. Methods: This case control study was conducted at Nephrology unit and Internal Medicine Department of Zagazig University Hospitals and Nephrology department of Theodor Biharz research institute. This study included 80 participants of both sexes across different age groups, all enrolled after providing written informed consent. The participants were divided into four groups: 20 healthy controls, 20 diabetic patients with normoalbuminuria (urinary albumin/creatinine <30 mg/gm), 20 diabetic patients with microalbuminuria (30–300 mg/gm), and 20 diabetic patients with macroalbuminuria (>300 mg/gm). All subjects underwent measurements of the common carotid artery intima-media thickness (IMT) using high-resolution real-time B-mode ultrasonography with a 7.5-MHz linear transducer (GE Logic F8 Expert). Serum Fetuin-A levels were assessed using an enzyme-linked immunosorbent assay (ELISA) kit, following the manufacturer's protocols. Results: There is statistically significant difference between the studied groups regarding serum Fetuin A, it was found significantly higher among cases compared to controls (p<0.001). There is statistically significant difference between the studied groups regarding diastolic dysfunction, diagnosis, and EF. On doing posthoc test, difference is significant between macroalbuminuric group and both control and microalbuminuric groups. (P<0.001). There is statistically significant positive relation between higher level of serum Fetuin-A and presence of Regional wall motion abnormalities (RWMA), diastolic dysfunction, aortic valve and mitral annular calcification, while there is significant negative correlation between serum Fetuin-A and ejection fraction (EF) (p<0.05). There is a statistically significant difference (p < 0.001**) in CIMT values across the studied groups, the macroalbuminuric group showed the highest CIMT value (1.54 ± 0.08), followed by the microalbuminuric group (1.32 ± 0.06), while the control (0.95 ± 0.1) and normoalbuminuric groups (0.91 ± 0.28) had the lowest values. Post-hoc analysis revealed significant differences between each pair of groups, except between the control and normoalbuminuric groups (p = 0.875), where there is no observed significant difference. Conclusions: the current study supports the growing body of evidence linking serum Fetuin-A levels to cardiovascular disease and bone mineral density deterioration in diabetic patients. Elevated serum Fetuin-A levels were strongly associated with vascular calcification, reduced cardiac function, and declining bone density.