Segmentation of vertebral contours is an essential task in the design of automatic tools for vertebral fracture assessment. In this paper, we propose a novel segmentation technique which does not require operator interaction. The proposed technique solves the segmentation problem in a hierarchical manner. In a first phase, a coarse estimate of the overall spine alignment and the vertebra locations is computed using a shape model sampling scheme. These samples are used to initialize a second phase of active shape model search, under a nonlinear model of vertebra appearance. The search is constrained by a conditional shape model, based on the variability of the coarse spine location estimates. The technique is evaluated on a data set of manually annotated lumbar radiographs. The results compare favorably to the previous work in automatic vertebra segmentation, in terms of both segmentation accuracy and failure rate.