A 56-year-old man was treated with bisphosphonates following incidental findings of vertebral deformities on a chest radiograph taken for cough. After re-evaluation with DEXA and spinal radiographs he was diagnosed with Scheuermann's disease, not osteoporosis. His gastrointestinal symptoms resolved after bisphosphonates were stopped. A 42-year-old man with limb-girdle muscular dystrophy and complaining of back pain underwent investigations. Radiographs showed loss of height in multiple thoracic vertebrae, yet DEXA bone mineral density was high-normal and an MRI scan suggested Scheuermann's disease. Recent osteoporotic vertebral fractures are an indication for anti-osteoporotic treatment, because they are highly predictive of future fracture risk. There are a number of differential diagnoses that should be considered in individuals with vertebral deformities, including Scheuermann's disease, especially if the clinical picture is not typically osteoporotic. This is important in order to avoid unnecessary medical treatment, which should be reserved for patients with osteoporosis. Refining vertebral fracture definitions may help to improve diagnostic accuracy.