Carbonare LD, et al. - Here, the authors examined histomorphometric parameters including bone microarchitecture in acromegaly patients with vertebral fractures (VFs) and normal bone mineral density (BMD) compared to normal subjects. Moreover, they aimed to assess the differences between active and controlled acromegaly patients. In acromegaly patients with a normal BMD, the apparent paradox of bone fragility could be explained by increased cortical thickness and porosity and reduced trabecular thickness with increased trabecular separation. Despite bone turnover normalization, these structural and microarchitectural abnormalities persisted in the controlled phase of acromegaly. After hormonal control, the main determinant of bone disease was severe osteoblastic dysfunction.