The prevalence and risk factors for vertebral deformity were studied in 396 community-dwelling Chinese men aged 70-79 years. Anterior to posterior (H(a)/H(p)), middle to posterior (H(m)/H(p)) and posterior to posterior (H(p)/H(p - 1) or H(p)/H(p + 1)) ratios from T5 to L5 were derived from lateral spine X-ray films, using standardized digitization methods. Using values of 3 standard deviations (SD) or more below the mean and 4 SD or more below the mean as the cutoff, 16% and 7% of these men, respectively, were deemed to have one or more deformed vertebra. Heavy cigarette smoking, heavy alcohol consumption, and working as a heavy manual worker were risk factors for vertebral deformity. Men with severe vertebral deformity (VHR < mean - 4 SD below mean) had much lower body weight, fat mass, and bone mineral density (BMD) than controls. The odds ratios for severe vertebral deformity was 9.9 (95% CI 2.1-45.7) in the lowest quartile of femoral neck BMD.