Mazziotti G, Battista C, Maffezzoni F, et al. - This retrospective, longitudinal study was undertaken to determine if in real-life clinical practice bone active drugs may lessen the risk of vertebral fractures (VFs) in patients with active or controlled acromegaly. The quantitative morphometric approach tested 248 patients with acromegaly (104 males; mean age 56.00 ± 13.60 years) for prevalent and incident VFs. Sixty-five patients developed incident VFs in relation to preexisting VFs, duration of active acromegaly, active acromegaly at the study entry, and treated hypoadrenalism during the follow-up. Treatment with bone active drugs did not have a significant impact on incident VFs in the entire population. However, treatment with bone active drugs was associated with a lower risk of incident VFs, irrespective of prevalent VFs and treated hypoadrenalism, in a sensitive analysis restricted to patients with active acromegaly at study entry. Bone active drugs can prevent VFs in active acromegaly patients.