Indeed, VFs may occur even after disease remission, particularly if hypogonadism, a reduction in BMD and/or trabecular bone score, diabetes, and/or previous VFs are present ( 5, 7). In fact, VF incidence is significantly higher in patients with active disease, previous history of prolonged active disease, or relevant delay in acromegaly diagnosis ( 5, 6). Differently from postmenopausal osteoporosis, VFs in acromegaly are not predicted by bone mineral density (BMD) measured by dual-energy x-ray absorptiometry (DXA), but are related to biochemical activity of the disease as well as disease duration ( 5). They are highly prevalent in acromegaly, being reported to affect from 30% up to 60% of patients ( 3) and represent an early event in disease history ( 4). Morphometric vertebral fractures (VFs) are an emerging landmark of skeletal fragility in the general population as well as in clinical trials. Among them, a specific acromegalic osteopathy has been discovered ( 2), characterized by fragility fractures associated with high bone turnover that need to be detected early, according to the most recent guidelines, since they are very frequent and related to chronic pain and reduced QoL ( 1). Growth hormone, IGF-I, acromegaly, vertebral fractures, cholecalciferolâ, vitamin DÄȘcromegaly, a chronic condition characterized by growth hormone (GH) and, in turn, insulin-like growth factor-1 (IGF-I) excess, is burdened by a series of systemic and metabolic comorbidities that strongly impair quality of life (QoL) and life expectancy ( 1).
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