We have read with interest the article on vertebral fractures after stopping Denosumab by Cummings SR et al. (1). Denosumab discontinuation is followed by a rebound effect with an increase of CTX above baseline values for two years and a decrease of BMD to baseline value after one year (2). Spontaneous clinical vertebral fractures, most often multiple, occur in the 8 to 16 months (median 11.2 months) following the last Denosumab injection (3). The risk of clinical vertebral fractures in the 12 months following the last Denosumab injection was evaluated at 7.3% (4). This risk is certainly higher with a follow-up of 16 months and the inclusion of non clinical fractures. Cummings SR et al. calculate an exposure-adjusted participant incidence of vertebral fractures (radiological and clinical) of 7.1 per 100 participant-years, from which only 39.3% where clinical fractures. We think that the difference between the previously published data and the actual study is due to the fact that the duration of the follow-up was not sufficient to capture all the vertebral fractures. Moreover, we found that this study has methodological caveats.