We studied 20 women who were at risk for osteoporosis (postmenopausal, or on dialysis, or on steroids), who presented with severe back pain. Patients underwent a dual photon (153Gd) densitometry study of the L2-L4 vertebrae, as well as an emission bone scan (99mTc-MDP). The dual photon method revealed abnormal results (20% or more below the mean expected value) in 13/20 patients (65%), and below the "fracture threshold" in 15/20 (75%). The emission bone scan delineated abnormal foci of uptake in 15/19 (79%). We conclude that women at risk for osteoporosis, who present with severe back pain, are likely to have a positive bone scan due to compression fracture or other derangements related to bone demineralization.