GH1 and osteoporosis: VFs are a landmark of acromegaly osteopathy as in other forms of secondary osteoporosis (9); they are not reliably predicted by BMD measured by DXA in acromegaly (31, 32), but predominantly by disease activity (specifically by GH levels) and active disease duration (5), being an early phenomenon in the natural history of the disease (4) and related to long diagnostic delay (6).