Among 2992 white women aged 65–70 years recruited from population-based listings, we measured radiographic vertebral dimensions of T5–L4 and calculated ratios of heights: anterior/posterior, mid/posterior, and posterior/posterior of either adjacent vertebra. The degree of deformity for each vertebra was analyzed in terms of the number of standard deviations (SD) that ratio differed from the mean ratio calculated for the same vertebral level in this population. We correlated the severity of each woman's worst vertebral deformity with back pain, back disability in six activities of daily living, and height loss since age 25. Only 39.4% of the cohort had no vertebral deformity; 10.2% had a deformity ≥ 4 SD. Vertebral deformities < 4 SD below the mean were not associated with increased back pain, disability, or loss of height. In contrast, women whose deformity was ≥ 4 SD had a 1.9 (95% CI, 1.5–2.4) times higher risk of moderate to severe back pain and a 2.6 (95% CI, 1.7–3.9) times higher risk of disability involving the back; they were also 2.5 (95% CI, 2.0–3.2) times more likely to have lost ≥ 4 cm in height. All three types of vertebral deformity (wedge, end plate, and crush) were equally associated with these outcomes. Multiple deformities < 4 SD did not increase the likelihood of these three outcomes, but multiple deformities >≥ 4 SD tended to be associated with increased back pain, disability, and height loss. This large cross-sectional study suggests that vertebral deformities cause substantial pain, disability, or loss of height only if vertebral height ratios fall 4 SD below the normal mean. Much back pain could not be attributed to vertebral deformities, suggesting other causes.