Purpose: To investigate overall prevalence of vertebral fractures (VF) in childhood survivors after acute lymphoblastic leukemia (ALL) treatment and examine the association of VF with insulin-like growth factors Methods: Children (n=172; mean age: 6.3 years; 59.3 % male) diagnosed with ALL at age between 2 and 18 years were assessed for VF by screening lateral thoracolumbar spine radiographs (Genant semi-quantitative method) when treatment is completed (baseline). Auxological measurements were obtained and the association of VF with insulin-like growth factor-1 (IGF-1) and binding protein-3 (IGFBP-3) were examined. Results: Thirty-five children (20.3 %) had vertebral fractures at baseline. Among children with vertebral fractures, 57.1 % had mild deformity, and 5th lumbar vertebrae was the most frequently injured site (20.0 %). Mean lumbar spine bone mineral density (LSBMD) Z-score was -1.2 ± 0.7 in children with VF. Baseline Z-scores for both height and weight were lower in children with VF than without VF (-0.5 ± 1.3, 0.0 ± 0.9; P = 0.01 and -0.2 ± 1.6, 0.3 ± 1.1; P = 0.04, respectively). Height Z-score in all children fell by 0.25 ± 0.8 ( P 0.01) after undergoing ALL treatment, and children with VF had greater height decline (0.5 ± 0.6) than without VF (0.2 ± 0.8) ( P = 0.02). Children with VF had lower IGF-1 and IGFBP-3 (187.9 ng/mL ± 118.6 and 2061.6 ng/mL ± 444.2) than without VF (252.1 ng/mL ± 91.5 and 2267.5 ng/mL ± 402.0) (both P 0.01). Decrease in IGF-1 level was associated with the presence of VF (R2 = 0.12, P = 0.02) and low LSBMD Z-score (R2 = 0.16, P = 0.02). Conclusion: Substantial number of children encounter VF after ALL treatment is completed, and the presence of VF is associated with compromised auxological state, prominent height decline, and IGF-1 deficiency.