As a highly vascularized tissue, the skeletal system can hardly perform its functions without the support from blood vessels in bone, and angiogenesis is closely associated with osteogenesis spatially and temporally. Recent studies have identified a new type of microvessels in bone marrow with distinct morphological, molecular, and functional properties, which were termed as type H vessels due to the high expression of platelet endothelial cell adhesion molecule-1 (PECAM-1/CD31) and endomucin (Emcn) in the endothelial cells. It was revealed that type H vessels were the key regulatory factors for the maintenance of angiogenesis-osteogenesis coupling, regulating physiological activities such as bone modeling and remodeling through interactions with osteoprogenitors, osteoblasts, and osteoclasts progenitors. Besides, type H vessels were also involved in the pathogenesis of various skeletal diseases like osteoporosis and osteoarthritis. This review aims to summarize the latest research progress on type H vessels and their role in bone disorders.