As secondary objectives, we investigated the correlation between the occurrence of incidental vertebral fractures (i-VFs) and other known relevant risk factors for VFs such as gender, age at the diagnosis of acromegaly, serum GH and IGF-I level (at diagnosis, at the start of second-line therapies and at last follow-up), prevalent vertebral fractures (p-VFs), hypopituitarism, and doses of substitutive hydrocortisone (or equivalent), glucose metabolism, use of vitamin D supplementation and bone active drugs, in both groups of treatment. Here, IGF1 is linked to hypopituitarism.