Osteoporosis in β-thalassemia is most prominent among male patients and can be attributed to many factors, such as endocrine disorders (parathyroid gland dysfunction, DM, hypothyroidism, hypogonadism), impairment in GH-IGF-I axis (growth hormone–insulin-like growth factor I), vitamin D deficiency, iron overload, bone marrow hyperplasia, liver disease, and cardiomyopathy (Table 1) [67,106]. Here, IGF1 is linked to Tangier disease.