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Recent reports show a correlation between haemophilia and osteoporosis. HIV, HCV and their treatments are independently associated with an increased risk of osteoporosis. Vitamin D plays a pivotal role in bone mineralization. The aim of our study was to compare Vitamin D levels, bone metabolism markers and bone mineral density ( BMD) in patients with haemophilia with or without co-infections. Seventy-eight adult patients with severe or moderate haemophilia A or B were subdivided into three groups of 26 patients each ( HIV- HCV co-infected, HCV mono-infected and uninfected). The BMD was measured by dual energy X-ray absorptiometry ( DXA) at both the femoral area (F) and lumbar spine (L). This was correlated to laboratory values and haemophilic arthropathy was assessed using validated clinical and radiological scores. The DXA showed a homogeneous F- BMD reduction in all the three groups, whereas L- BMD was significantly lower in co-infected patients ( P < 0.05). The clinical score was higher in co-infected ( P < 0.002) and mono-infected ( P < 0.006). The radiological score was higher in mono-infected than in the other two groups ( P < 0.001). Overall 25-hydroxyvitamin D (25-OH Vit D) was reduced (87%). Bone-specific alkaline phosphatase (b- ALP) and telopeptide were increased in co-infected ( P < 0.001 and P < 0.01) and mono-infected ( P < 0.001 and P < 0.02). The result of the homogeneous F- BMD reduction in all groups could be explained by the pivotal role of arthropathy; the lower L- BMD in co-infected and the increase of b- ALP and telopeptide in co-infected and mono-infected groups suggest faster bone metabolism in case of infections. [ABSTRACT FROM AUTHOR]