Comments: Focal structural anomalies lead to exclusion of L1 and L2. The 3rd lumbar vertebra is retained despite similar anomalies, because the L3-L4 T-score is low (-2.6) and may provide clinically useful information to the treating physician. Spine films demonstrate abdominal aortic calcification, an L4 compression fracture and severe obliquity of the lumbar spine from scoliosis. A densitometric diagnosis of severe or established osteoporosis is warranted on the basis of the L3-L4 T-score and the history of a low trauma L4 compression fracture.

AP