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Fourteen patients (6.9%) experienced incident VFs during the follow-up (median duration 30 months, range 18-48), in relationship with non- adherence to denosumab therapy (Hazard Ratio 4.44; C.I. 95% 1.01-19.47) and smaller increase in lumbar spine BMD (Hazard Ratio 0.85, C.I. 95% 0.76-0.94). CONCLUSIONS In post-menopausal women at high risk of fractures, the small delay in the administration of denosumab (i.e., not uncommon in clinical practice) was associated with a significant increase of incidence of VFs. Preservation of standard d