A new constellation of spinal changes are observed in homozygous beta-thalassemia major (HBT) patients receiving deferoxamine (DF), an iron-chelating drug used in combination with transfusion therapy in certain anemic syndromes. In a retrospective study of 22 HBT patients who were receiving DF therapy, morphological deformities (decreased spinal height, increased thoracic kyphosis, vertebral flattening and elongation anteriorly, and disk calcification) were found in 16 of 22 patients. These changes are believed to be caused by interference with spinal growth-plate development. Investigation of DF-dose correlation supports the conclusion that the spinal changes were DF-induced. Spinal changes observed in DF-treated patients differ both morphologically and pathogenetically from earlier reports of vertebral deformities occurring as a sequel to compensatory marrow hyperplasia in poorly transfused patients.