People with acromegaly (high IGF‑1) often have weak bones and fractures, and this isn’t tied to their age, weight, or how long they’ve had the disease. Even though IGF‑1 is high, it doesn’t protect against osteoporosis, and those on certain drugs (somatostatin analogs) seem to have it more often.

Acromegaly, a disease of excess growth hormone, is known to alter bone structure and increase the risk of osteoporosis and fractures. This study aimed to assess the prevalence of vertebral, non-vertebral, and hip fragility fractures, as well as osteoporosis, in a cohort of patients with acromegaly. To assess the prevalence of vertebral fragility fractures, non-vertebral fragility fractures, hip fragility fractures, and osteoporosis in patients diagnosed with acromegaly. Data were collected on age, sex, body mass index (BMI), time from diagnosis of acromegaly, insulin-like growth factor (IGF-1) levels, disease control, pharmacological management, risk factors for osteoporosis, vertebral fragility fractures, non-vertebral fragility fractures, hip fragility fractures, and osteoporosis. A total of 124 patients with acromegaly were included (67 men and 57 women). The mean age at diagnosis was 44 &#xb1; 12 years; the mean time from diagnosis was 12 &#xb1; 8 years; and the mean BMI was 27 &#xb1; 4 kg/m&#xb2;. Fragility fractures were found in 27 patients (21%). There were no significant differences in the presence of osteoporosis or fragility fractures according to age, sex, BMI, duration of acromegaly, or IGF-1 levels at diagnosis. A higher percentage of patients with osteoporosis were treated with somatostatin analogs compared to those without osteoporosis (46% <i>vs</i> 15%; <i>P</i> &lt; 0.05). A high prevalence of osteoporosis and fragility fractures was found in patients with acromegaly, regardless of age, sex, BMI, time from diagnosis, IGF-1 levels, and disease control. More patients with osteoporosis were treated with somatostatin analogs compared to those without osteoporosis. Taken together, our results suggest that the severity of the disease and the need for second-line therapies, may be associated with the increased risk of osteoporosis.