Do vegans suffer more bone fractures?

Concerns have been raised by two recent scientific publications on the risk of bone fractures in people following a vegan diet. Before dismissing these new findings, we should carefully assess the results and consider some important take home messages. This does not mean that you need to ‘give up’ your vegan diet, just that you need to take care that it is healthy and that you are meeting your nutritional requirements. This is not difficult to achieve.

The reports come from the two largest and longest running studies on the health of vegetarians and vegans. The first study is a report from the EPIC-Oxford cohort, which includes more than 65,000 participants from the UK and has been following them since 1993. The study showed that compared to meat eater’s, vegans had a 43% increased risk of developing a fracture. Although this figure sounds alarming, in absolute terms, it works out at 19 extra cases of fractures in vegans for every 1000 people over 10 years. However, the finding was only relevant to women with a body mass index (BMI) below 22.5. For all men and women with a BMI equal or greater to 22.5, there was no longer an increased risk of fracture. We also know from prior reports that the vegans in this study had lower than recommended intakes of calcium, vitamin D and vitamin B12, which could all be playing a part in this increased risk.

The second study is a report from the Adventist Health Study 2, which includes more than 96,000 Adventists from North America that have been followed since 2002. The study showed that vegans have a 55% increased risk of developing a hip fracture compared to omnivores. Again, this figure sounds alarming, but in absolute terms amounts to 1.5 extra hip fractures per 1000 vegans per year. Again, the increased risk was only seen in women, not men, and this time the risk completely disappeared in vegans taking both calcium and vitamin D supplements.

Bone health is complicated and so many factors play a role. In fact, regular weight-bearing physical activity is probably more important than diet alone. Nonetheless, we do need to ensure a vegan diet is providing all the nutrients we need for bone health. There is a long list of important nutrients including calcium, vitamin D, zinc, vitamin B12, protein and vitamin K. In addition, avoiding food and lifestyle habits that adversely affect bone health is also important, such as alcohol, tobacco smoking, too much salt and fizzy drinks. Here are some great articles by our dietitian Lisa Simon on meeting your calcium, zinc and protein needs.

We also mustn’t forget that both these same studies have previously shown a number of health benefits for those following a vegan diet including around a 50% reduction in risk of high blood pressure, significantly lower levels of blood cholesterol, a 25–30% reduction in ischaemic heart disease (this includes vegetarians as well), 15% reduction in cancer risk and a 30–40% reduction in risk of type 2 diabetes in those not eating meat. These are all major causes of death and disability in the UK and a far greater risk to personal and public health than bone fractures.

There is no reason to ditch your vegan diet, but this serves as a reminder that you need to focus on eating a healthy diet. This could be said for all dietary patterns, not just vegan.

If you need help optimising your vegan diet, you can book an appointment with the team at Plant Based Health Online.