Is a vegan diet linked with a higher risk of bone fractures?
‘A vegan diet may be linked to a higher risk of bone fractures’. Headlines like these have been in the news recently after the publication of findings from the EPIC-Oxford study.
Analysis of data from 55,000 men and women in the UK found that compared to meat eaters, vegans had a 43% higher risk of fractures. The biggest differences were for hip fractures, where the risk in vegans was 2.3 times higher than in people who ate meat. This is equivalent to 15 more cases per 1000 people over 10 years.
The authors of the study said the differences in risk may be partially explained by the lower average body mass index (BMI) and lower average intakes of Calcium and protein in non-meat eaters, and other potential factors.
Whichever way you interpret the results, it is a good reminder of the important nutrients needed to build strong bones in all of us - whatever our diet - when growing up and throughout adulthood. An active lifestyle, not smoking or drinking too much alcohol are key, and so is ensuring these essential nutrients are in your diet.
The richest sources of Calcium in the diet are milk and dairy products, with milk, yoghurt and cheese providing about half of the Calcium consumed in the UK diet.
It can be tricky to get enough Calcium if you don’t consume dairy, but there are a variety of foods with Calcium for vegans. These include:
- Non-dairy milk or yoghurt alternatives fortified with Calcium.
- Calcium-set tofu (check for calcium sulphate or chloride in the ingredients).
- Sesame seeds, sesame seed paste, and tahini.
- Beans and chickpeas, or hummus.
- Brown and white bread – in the UK Calcium is added to all white and brown bread.
- Dried fruits including raisins, apricots, prunes and figs.
It’s difficult to talk about Calcium without mentioning Vitamin D because Vitamin D is essential for helping the body absorb Calcium from the foods we eat.
A vegan diet contains very little Vitamin D without fortified foods or supplements. If following a vegan diet, include foods fortified with Vitamin D such as plant based dairy alternatives, breakfast cereals and some vegetable spreads, and Vitamin D rich foods such as mushrooms.
Your body produces Vitamin D from direct sunlight on your skin but with so little sun, we are nearly all deficient in Vitamin D during the autumn and winter months so the Government recommends all adults should take a daily Vitamin D supplement at this time.
Bone is made up of a protein matrix which is strengthened with minerals such as Calcium and phosphorus.
If you’re following a vegan diet, ensure most of your meals contain some protein foods such as lentils, beans, chickpeas, tofu, soya products (e.g soya milk, yoghurt or mince), Quorn and quinoa, as well as nuts and seeds.
There are at least three Vitamin K dependent proteins found in our bones, and people with weak bones or conditions such as osteoporosis have been shown to have low blood levels of Vitamin K.
Good food sources of Vitamin K are green leafy vegetables such as broccoli and spinach, vegetable oils and cereal grains.
Magnesium has many functions throughout you body and a key role is helping maintain your healthy bones – approximately 60% of the Magnesium in your body is found in your bones.
Good plant foods with Magnesium are wholemeal bread, nuts, legumes and green leafy vegetables.
Despite being in a wide range of foods, low intakes of Magnesium are common in the UK. See our previous article 'How do I know if I'm deficient in Magnesium' for more on this.
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What else helps support our bone health?
Regular activity, particularly weight bearing and muscle strengthening activity such as brisk walking, jogging, weight lifting or even dancing, is hugely important for building and maintaining strong bones.
Maintain a healthy weight
Bones respond to the weight they carry, which means that low body weight (a BMI of under 19) can increase your risk of weaker bones and osteoporosis (BDA, 2019). Maintaining or working towards a healthy body weight is beneficial for bone health. See our section on Bone health for more information.
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BDA (2019) Osteoporosis and diet: Food Fact Sheet. Available: https://www.bda.uk.com/resource/osteoporosis-diet.html
BNF (2018) Bone and joint health. Available:
Tong et al (2020) Vegetarian and vegan diets and risks of total and site-specific fractures: results from the prospective EPIC-Oxford study. Available: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-020-01815-3