Patients with indolent systemic mastocytosis (ISM) had more vertebral fractures, particularly biconcave vertebral fractures, than those with primary osteoporosis. "Incorporating this parameter into existing diagnostic pathways may help reduce diagnostic delays, prevent misclassification as primary osteoporosis, and guide more appropriate therapeutic decision-making in this high-risk population," they added. This study was led by Gaetano Paride Arcidiacono, University of Padova, Padua, Italy. It was published online on December 10, 2025, in Osteoporosis International. The study's small sample size may have limited generalisability. The mechanism underlying biconcave fracture morphology in SM remains unclear. Open access funding was provided by Università degli Studi di Padova within the CRUI-CARE Agreement. The authors declared having no conflicts of interest. This article was created using several editorial tools, including AI, as part of the process. Arcidiacono GP, Torres MO, Zanchetta F, et al. Biconcave vertebral fractures as a possible distinctive feature of indolent systemic mastocytosis compared with primary osteoporosis.