DescriptionObesity is a risk factor for osteoarthritis and spinal stenosis. Weight loss can cause declines in bone mineral density (BMD), this is not consistently observed at the lumbar spine (LS). It is hypothesized that this inconsistency may be due vertebral structural abnormalities, and so, excluding these defects along with examining the LS trabecular bone score (TBS) may be a more sensitive indicator of bone changes due to weight loss and aging. Retrospective analysis of BMD and TBS in 131 older overweight/obese women and men (body mass index, BMI, 32.72 ± 4.6 kg/m2 and 60 ± 6 years) who participated in previous weight loss studies. To control for abnormalities in the lumbar spine image, we assessed dual energy x-ray absorptiometry LS images for vertebral body exclusion (VE) criteria. At study completion participants were divided into those who had a weight loss of less than or greater than 5%. Mean LS-BMD value was lower after correction for abnormalities (p<0.05). In only the corrected LS-BMD there was a decrease that trended towards being greater due to weight loss. TBS was partially degraded in ~50% of these older individuals. Repeated measures ANOVA (group by time) indicated no significant TBS interaction with weight loss and time. The vertebral abnormalities differentially effected LS BMD during weight loss and aging and because of this, all LS BMD images should be analyzed for vertebral abnormalities.