Thalassaemia is an inherited disorder of red blood cells. In its more severe form chronic transfusion and concomitant iron chelation is necessary to prevent the complications of iron overload. Thalassaemia-associated bone disease is a well-recognised complication with significant morbidity. However, our understanding of thalassemia bone disease is incomplete but a variety of risk factors have been identified, which include: genetic factors, hormonal deficiency, marrow expansion, skeletal dysmorphism, iron toxicity, chelators, increased bone turnover and renal tubular dysfunction. The multiple contributing factors to bone loss presents diagnostic and therapeutic challenges in thalassemia, but also emphasizes the importance of an integrated approach to management between different medical specialty units.