Increased Risk of Bone Fractures in Non-meat Eaters

Sarfaroj Khan 


December 15, 2020


  • Compared with meat eaters, vegans were at an increased risk of total and site-specific fracture of the hip, leg and vertebrae.

  • Vegetarians and fish eaters had a higher risk of hip fractures than meat eaters.

Why this matters

  • Findings suggest that bone health in vegans requires further research.

Study design

  • Dietary information of 54,898 participants in the EPIC-Oxford study was collected at baseline (1993-2001) and follow-up (2010).

  • Participants were categorised into meat eaters (n=29,380), fish eaters (n=8037), vegetarians (n=15,499) and vegans (n=1982) at both time points and followed continuously for 17.6 years on average until 2016 for the occurrence of fractures.

  • Funding: UK Medical Research Council and others.

Key results

  • 3941 fractures occurred in total, including 566 arm, 889 wrist, 945 hip, 366 leg, 520 ankle and 467 fractures at other main sites, defined as the clavicle, ribs and vertebrae.

  • After adjustments for socio-economic factors, lifestyle confounders and body mass index (BMI), compared with meat eaters, the risks of hip fracture were higher in:

    • fish eaters (adjusted HR [aHR], 1.26; 95% CI, 1.02-1.54);

    • vegetarians (aHR, 1.25; 95% CI, 1.04-1.50); and

    • vegans (aHR, 2.31; 95% CI, 1.66-3.22).

  • The vegans also had higher risks of:

    • total fracture (aHR, 1.43; 95% CI, 1.20-1.70);

    • hip fracture (aHR, 2.31; 95% CI, 1.66-3.22);

    • leg fracture (aHR, 2.05; 95% CI, 1.23-3.41); and

    • other main site fractures (aHR, 1.59; 95% CI, 1.02-2.50).

  • Overall, the significant associations were stronger before adjustment for BMI and were slightly attenuated but remained significant after further adjustment for dietary calcium and/or total protein.

  • No significant differences were seen in risks for arm, wrist and ankle fractures between diet groups.     


  • The cause of fracture or calcium that was taken in supplement form was not considered.

  • Limited generalisability.


Tong TYN, Appleby PN, Armstrong MEG, Fensom GK, Knuppel A, Papier K, Perez-Cornago A, Travis RC, Key TJ. Vegetarian and vegan diets and risks of total and site-specific fractures: results from the prospective EPIC-Oxford study. BMC Med. 2020;18(1):353. doi: 10.1186/s12916-020-01815-3. PMID: 33222682 View full text

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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