Vegans and Vegetarians Might Be at Risk for Bone Fractures, Study Shows

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Key Takeaways

  • Compared to meat-eaters, vegetarians and vegans are more likely to experience fractures, but the risk is only slightly higher.
  • Bone health can be maintained without animal-based options if vegetarians and vegans pay attention to specific nutrient intake.

A recent study published in BMC Medicine explored whether or not non-meat eaters faced a greater risk of fractures than meat-eaters. The study was conducted in the UK from 1993 to 2001 with a follow-up done an average of 17.6 years later. The results indicate that vegans have a 43% increased risk of fractures compared to non-meat eaters. Vegetarians have a 9% increased risk.

The study included nearly 55,000 participants, and slightly less than half were vegetarians, vegans, or pescatarians. Researchers say 3,941 fractures occurred over the course of the study. Non-meat eaters were more likely to develop fractures in certain areas, such as the hips, legs, and clavicle. Vegans were over twice as likely as meat eaters to experience hip and/or leg fractures. Arm, ankle, and wrist fracture risks were not increased in non-meat eaters.

When analyzing the above data, researchers took menopausal status and BMI (a lower body weight can impact bone density) into account. When they adjusted the results to take calcium intake into account, the associations were reduced but still significant for vegans. This study was the first of its kind to address bone health in plant-based diets, and it is proof that further research is needed.

Is Meat Necessary for Bone Health? 

Is meat necessary for bone health? Not necessarily. Sherene Chou, MS, RD, says that, instead of over-focusing on the fractures, experts should be encouraging everyone—vegetarian or not—to eat for their bone health. Chou, who is a plant-based dietitian, gives her analysis of the study: “We should not conclude that vegetarians and vegans have weak bones and need meat, as that would be inaccurate.

The main data show that 14 to 15 more cases of hip fractures in vegans compared to meat-eaters per 1,000 people over a 10-year period. We should focus on how to enhance and support bone health for vegans, vegetarians, and meat eaters alike.” 

While the study was conducted in the UK, it is worth noting that an estimated 10 million Americans over the age of 50 have osteoporosis, and an additional 43 million have low bone mass. A Gallup poll showed that as of 2018, only 2% of Americans over 55 are likely to be vegetarian, and only 5% of the total population identifies as vegetarian. While the BMC Medicine study may show a slight increase in fractures for non-meat eaters, it does not explain why so many people in the US have low bone density.

Brooke O'Connell, RDN

With any eating pattern, it is important to take pride in thoughtfully planning your diet to ensure you meet your daily nutrition needs." Brooke O’Connell, RDN

— Brooke O'Connell, RDN

A 2012 study that reviewed the average American diet in The Open Orthopaedics Journal listed the most important nutrients for bone health. In order of amount needed, these include vitamin D, calcium, magnesium, vitamin C, silicon, zinc, manganese, copper, boron, and vitamin K. A healthy diet should provide all of these, but many Americans are not getting all of the nutrients necessary for bone health.

The study emphasized that exercise is also crucial for bone density. Exercise aids in strength and balance, which prevent falls in older Americans. However, Americans may not be getting enough of it to support bone health. Prior research shows 40% of adults do not partake in leisurely physical activity, and over two-thirds of high schoolers get less than the recommended amount of exercise.

Got Milk? 

Many Americans have solely relied on milk for bone health. Some even having a glass at every meal. A major reason for this is that for over 100 years, the US government has propped up milk consumption and advertised it as the most effective way to protect bones. It is recommended that we get two to three servings of dairy daily.

Brooke O’Connell, RDN, CSR, LDN, at Optimum Nutrition explains that vegetables are often left out of the calcium conversation. “Many greens—such as collards, turnip greens, kale, okra, mustard greens, and broccoli—contain calcium. Vegans may consider fortified foods such as certain juices, breakfast foods, non-dairy milks...and breads that may contain vitamin D and calcium.”

The BMC Medicine study stated that pescatarians are also at higher risk for hip fractures, but many do consume dairy. Plus, many types of fish are rich in vitamin D, which is necessary for calcium absorption. O’Connell says, “Canned sardines and salmon with bones, as well as fatty fish such as salmon, mackerel, tuna, and sardines, all contain vitamin D.”  

Chou adds, “Beans, soy, nuts, and seeds throughout the day, calcium-fortified plant milks or juices, [and] resistance or weight-bearing exercises are vital. To protect your bones on a plant-based diet, these are some nutrients that are not lacking but may require special attention: protein, which enhances calcium absorption, calcium, vitamin D, B12, and an addition of weight-bearing exercise.” 

Chou’s Plant-Based Smoothie, via Nutribullet

  • 1 cup spinach
  • ½ banana, frozen
  • 1 1/2 cup almond milk, vanilla, unsweetened
  • 1/4 cup rolled oats
  • 1 tbsp peanut butter, creamy, unsalted
  • 1 tbsp Honey

Blend all of the ingredients until smooth.

— Chou’s Plant-Based Smoothie, via Nutribullet

Plant-Based Recommendations for Health

Vegetarian and vegan diets, like meat-based ones, are not one-size-fits-all. According to O'Connell, “Dietary patterns may vary from person to person, especially since there are a variety of food options available to choose from. A vegetarian and vegan diet may include vegetables, fruits, whole grain sources, legumes, or nuts and seeds. With any eating pattern, it is important to take pride in thoughtfully planning your diet to ensure you meet your daily nutrition needs.” 

O’Connell recommends plant-based diets be rich in protein, iron, Vitamin B12, omega-3 fatty acids, and iodine, on top of micronutrients specific to bone health. “Many vegetarians tend to have less iron stored in their bodies than those who eat meat, and vitamin B12 is not a component of plant foods.”

She explains that omega-3s can be found in seeds, walnuts, and plant oils. Many leafy greens, nuts, and grains are iron-rich foods, and vitamin B12 can be supplemented in fortified foods. That includes plant-based protein powders.

What This Means for You

Whether you consume meat or a plant-based diet, bone health cannot be ignored. If you're not eating meat, pay close attention to your intake of specific bone-strengthening vitamins and minerals, preferably in real food form. Exercise is also essential for strengthening bones and preventing falls that can result in hip fractures. 

7 Sources
Verywell Fit uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Tong TYN, Appleby PN, Armstrong MEG, et al. Vegetarian and vegan diets and risks of total and site-specific fractures: results from the prospective EPIC-Oxford studyBMC Med. 2020;18(1):353. doi:10.1186/s12916-020-01815-3

  2. Wright NC, Looker AC, Saag KG, et al. The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spineJ Bone Miner Res. 2014;29(11):2520-2526. doi:10.1002/jbmr.2269

  3. Gallup. What Percentage of Americans Are Vegetarian?.

  4. Price CT, Langford JR, Liporace FA. Essential nutrients for bone health and a review of their availability in the average North American diet. Open Orthop J. 2012;6:143-149. doi:10.2174/1874325001206010143  

  5. National Milk Producers Federation. Legacy of Leadership: 1916-2016.

  6. U.S. Department of Agriculture. ChooseMyPlate | All about the dairy group.

  7. National Institutes of Health; Office of Dietary Supplements. Vitamin D: Fact Sheet for Health Professionals.