GH1 and hypothyroidism: The most importantfactors for osteoporosis in thalassemia includedelayed puberty, diabetes mellitus, hypothyroidism,ineffective hematopoiesis with bone marrow hyperplasia,parathyroid gland dysfunction, toxic effectof iron on osteoblasts and deficiency of growthhormone/insulin-like growth factor-1 (GH/IGF-1).In general, decreased bone density and osteoporosisare the result of a disrupted balance between osteoblastsand osteoclasts (5, 6).