Morphometric X-ray absorptiometry (MXA) offers some potential advantages over spinal radiography for the quantitative evaluation of vertebral fractures in individuals with spinal osteoporosis. This ex vivo study examined the accuracy of MXA and quantitative morphometry (QM) for the evaluation of vertebral height, in relation to direct measurements from cadaveric vertebral columns. Spinal radiographs and MXA scans were obtained from nine cadaveric vertebral columns (mean age at death 64 years). Anterior, middle and posterior vertebral body heights of all segments from T4 to L4 were measured interactively using MXA software and QM (from the spinal radiographs), and compared with direct measurements derived using digital callipers following cadaveric dissection. Coefficients of variation for repeat QM and MXA scan analysis were less than 2%. The QM and MXA measurements were both strongly correlated (r(2) = 0.99) with the direct measurements, with accuracy errors of between 2.6% and 4.3%, and 4.5% and 4.8%, for QM and MXA respectively. At the three measurement sites, analysis of measurement differences showed that QM tended to overestimate the true height and MXA tended towards under-estimation. The mean difference between the direct measurements and QM measurements ranged from 2.7% to 8.7%, and the mean difference between direct and MXA measurements ranged from -2. 9% to 4.1%. There was strong linear association between the MXA and QM measurements (r(2) = 0.99) with mean differences at the three measurement sites ranging from -4.1% to -5.9%. Under the optimal (ex vivo) scanning conditions used in this study, MXA is comparable to spinal radiography for the assessment of vertebral height. Further studies are required to determine the conditions under which satisfactory MXA image resolution and measurement accuracy can be achieved in a clinical population.