Background: The survival of patients with thalassemia major has progressively improved with advances in therapy; however, osteoporosis and cardiac dysfunction remain frequent complications. Adequate circulating levels of vitamin D are essential for optimal skeletal health and reducing fracture risk this study aimed to evaluate the density of bone mineral (BMD) and vitamin D status in patients with β-thalassemia major (β-TM). Methods: The current study was carried on thirty three β-thalassemic childrens who attend the Pediatric Hematology Clinic at Zagazig University Hospitals during the period from April 2018 to October 2018 (21 male and 12 female). Dual-energy X-ray absorptiometry scan was used to evaluate bone density and interpreted as Z-score which compared to the BMD of age, sex and ethnicity-matched reference population. Biochemical parameters such as calcium, serum ferritin (SF) and 25-OH Vitamin D have been evaluated. Results: there were significant increase in serum ferritine level, AST, ALT, ALP, total bilirubin and urea and decrease in total protien , serum albumin and criatinine in the thalassaemic patients than controls. There was significant low level of vitamin k2 in the thalassaemic patients than controls Conclusion: Osteopathy has a high prevalence in patients with β-TM and should receive an optimal transfusion and chelation therapy to prevent bone expansion. Calcium and Vitamin D should be routinely determined to prevent deficiency.