Study analysis · BMC Medicine · 2020
Vegans are 2.3 times more likely to break a hip than meat eaters — and it's not just because they're thinner.
A large UK study found that people on vegan diets have significantly higher risks of broken bones, especially hip fractures, compared to meat eaters, even after considering weight and nutrient intake.
Overview
What the study found
The study in plain English — the bottom line, every takeaway we extracted, and what to do with them.
In simple terms
This study is like watching a big group of people over many years to see who breaks bones. It found that people who don't eat meat, especially vegans, have more broken bones than meat eaters. But this doesn't prove that not eating meat causes broken bones—it could be something else about those people, like being thinner or having lower calcium. So we can say they are linked, but we can't say one causes the other.
What’s the bottom line?
Researchers in the UK followed over 54,000 people for almost 18 years to see if people who don't eat meat have more broken bones. They found that vegans had more broken bones overall, especially hip fractures, compared to meat eaters. Fish eaters and vegetarians also had slightly more hip fractures. This doesn't prove that these diets cause fractures, but it suggests they might be linked.
How strong is this study?
This is a very big and long study, which is good. They followed almost 55,000 people for about 17 years and checked hospital records for fractures, which is reliable. But it's not a perfect experiment—the people chose what to eat, so there might be other differences. The study tried to adjust for many things, but we can't be sure everything is accounted for. So it gives strong clues, but not absolute proof.
75 / 100
- COI disclosure+40/40
- Data availability+35/35
- Code availabilitycode not shared
38 / 100
- Randomizationnot randomized
- Blindingblinding unclear
- Control groupno control group
- Sample size (n=54898)+20/20
- Follow-up+10/10
100 / 100
77 / 100
- P-values+15/15
- Effect size+20/20
- Confidence intervals+15/15
- Pre-registrationnot pre-registered
Each component is scored out of 100 and then capped by the study design — a case series cannot reach the ceiling a randomised trial can, however well it is reported.
Where it sits
RCT reviewsReviews of RCTs (Meta-analyses)
Max 100Randomized TrialsRandomized Trials
Max 90Reviews of Cohort StudiesReviews of Cohort Studies
Max 85Cohort StudiesCohort Studies
Max 72Reviews of Case-Control StudiesReviews of Case-Control Studies
Max 63Case-Control StudiesCase-Control Studies
Max 58Cross-Sectional & Case SeriesCross-Sectional & Case Series
Max 50Expert OpinionExpert Opinion
Max 567 / 100
Probability of being correct
Groups of people are followed over time to see who develops an outcome. Strong for identifying risk factors and associations, but cannot prove causation as firmly as RCTs.
This design cannot establish causation — the findings describe an association, not a cause. Observational cohort study cannot establish cause-effect relationships. Residual confounding, selection bias, and reverse causation cannot be ruled out. Diet was self-reported and may have misclassification. The association may be due to lifestyle factors or other unmeasured confounders.
COI Unknown
Could not determine conflict of interest status
No funding or conflict of interest information is provided in the given text; the study appears to be an academic observational study.
The text provided does not include declarations on funding or conflicts. Since the study is from a large academic cohort, it may have received public grants, but this is not mentioned.
Key takeaways
- 01
Vegans had about 43% more total fractures and 131% more hip fractures than meat eaters.
- 02
Fish eaters and vegetarians had about 25% more hip fractures.
- 03
These numbers were adjusted for factors like weight, smoking, and activity.
- 04
For a human, this means that if 1,000 vegans are followed for 10 years, about 15 more of them will have a hip fracture compared to 1,000 meat eaters.
- 05
For fish eaters and vegetarians, it's about 3 more hip fractures per 1,000 people over 10 years.
Surprising findings
- Even after adjusting for calcium and protein intake, vegans still had a 30% higher risk of total fractures.Common wisdom suggests that supplementing calcium and eating enough protein should mitigate bone risks, but this study shows it's not sufficient.
- Vegetarians and fish eaters had about 25% higher risk of hip fracture, but not total fractures, suggesting site-specific vulnerability.You'd think vegetarians who eat dairy or fish would get enough nutrients, but they still show increased hip fracture risk.
- Vegans had a 2.05 times higher risk of leg fractures and 2.42 times higher risk of vertebral fractures compared to meat eaters.These are often osteoporotic fractures, indicating poor bone quality in areas prone to fragility.
Practical takeaways
If you're vegan or vegetarian, ensure adequate intake of bone-supporting nutrients: calcium, vitamin D, protein, vitamin B12, and possibly omega-3s. Consider periodic bone density tests if you're over 50 or have other risk factors.
This is an observational study, so we can't say for sure that diet causes the increased risk. Also, the study was mostly white Europeans, so results may not apply to all populations.
medium confidenceFor vegans, consider strength training and weight-bearing exercise to build bone density and muscle strength, which can protect against falls and fractures.
The study didn't measure exercise objectively, but other research suggests muscle strength is protective.
medium confidenceDon't panic if you're vegan—the absolute risk increase is modest. For example, about 15 extra hip fractures per 1,000 people over 10 years. That's 1.5% absolute increase.
But for individuals, a hip fracture can be life-changing, so it's worth paying attention to bone health.
high confidenceWhy this study matters
The Veganism Paradox: Lower BMI, Higher Fracture Risk
Vegans in the EPIC-Oxford study had a 43% higher risk of total fractures and a 2.31 times higher risk of hip fractures compared to meat eaters. This was after adjusting for BMI, suggesting that being thinner (which is generally protective for heart disease) doesn't protect bones in this group.
Many people choose vegan diets for health reasons, but this study highlights a potential trade-off. The assumption that 'plant-based = healthier' is challenged when it comes to bone integrity.
Calcium and Protein: The Usual Suspects Aren't the Whole Story
Even after statistically adjusting for calcium and protein intake, vegans still had a 30% higher risk of total fractures. This suggests that other factors—like vitamin D, vitamin B12, IGF-1, or overall bone density—may play a role.
It's not just about supplementing calcium. There might be something else about animal-based nutrients that supports bone strength, or the lack thereof in vegan diets.
Hip Fractures: A Game-Changer for Aging Vegans
The risk of hip fracture was 14.9 more cases per 1,000 people over 10 years for vegans compared to meat eaters. With hip fractures often leading to loss of independence, this is a serious public health concern for the growing vegan population.
Hip fractures are a major marker of frailty and mortality in older adults. This number puts the risk into perspective—it's not negligible.
Not All Fractures Are Equal: Site-Specific Differences
While vegans had higher risks for hip, leg, and vertebral fractures, there was no difference in wrist or ankle fractures. This suggests the issue is more about bone quality in weight-bearing bones, not just overall fall risk.
It challenges the idea that all bones are equally affected. It might be about bone density in specific areas or different mechanisms.
The Role of Body Weight: Thinner Bones?
Adjusting for BMI attenuated the associations, meaning some of the risk is due to vegans' lower body weight. But even after that, vegans had a 43% higher risk of total fractures, so it's not just about being skinny.
Lower BMI is usually protective for many conditions, but here it contributes to fracture risk. There's a sweet spot for bone health.
Want the whole report?
Detailed mode opens the full scientific breakdown — every score component, the methodology, conflicts of interest, the evidence analysis behind each claim, and the raw study data.
Overview
What the study found
The study in plain English — the bottom line, every takeaway we extracted, and what to do with them.
Not medical advice. For informational purposes only. Always consult a healthcare professional. Terms
Researchers in the UK followed over 54,000 people for almost 18 years to see if people who don't eat meat have more broken bones. They found that vegans had more broken bones overall, especially hip fractures, compared to meat eaters. Fish eaters and vegetarians also had slightly more hip fractures. This doesn't prove that these diets cause fractures, but it suggests they might be linked.
Research results
Vegans had about 43% more total fractures and 131% more hip fractures than meat eaters. Fish eaters and vegetarians had about 25% more hip fractures. These numbers were adjusted for factors like weight, smoking, and activity.
What this means - more context
For a human, this means that if 1,000 vegans are followed for 10 years, about 15 more of them will have a hip fracture compared to 1,000 meat eaters. For fish eaters and vegetarians, it's about 3 more hip fractures per 1,000 people over 10 years.
To examine the risks of total and site-specific fractures in vegetarians, vegans, fish eaters, and meat eaters in a large UK prospective cohort.
In the EPIC-Oxford study with 54,898 participants and 17.6 years of follow-up, vegans had 43% higher risk of total fractures (HR 1.43, 95% CI 1.20-1.70) and 2.31 times higher risk of hip fractures (HR 2.31, 95% CI 1.66-3.22) compared to meat eaters. Fish eaters and vegetarians had 25-26% higher hip fracture risk. Associations were partially explained by BMI, calcium, and protein intake but remained significant for vegans. The study has corrections; readers should check for updated information.
Methods Used
Prospective cohort study using EPIC-Oxford data. 54,898 participants (29,380 meat eaters, 8,037 fish eaters, 15,499 vegetarians, 1,982 vegans). Diet groups assessed at baseline and follow-up. Outcomes ascertained via hospital records and death certificates. Multivariable Cox regression adjusted for lifestyle and sociodemographic factors, with and without BMI adjustment.
Main Finding
Compared to meat eaters, vegans had higher risks of total fractures (HR 1.43, 95% CI 1.20-1.70), hip fractures (HR 2.31, 95% CI 1.66-3.22), leg fractures (HR 2.05, 95% CI 1.23-3.41), and vertebral fractures (HR 2.42, 95% CI 2.31-4.48) after adjustment for BMI and confounders. Fish eaters and vegetarians had increased hip fracture risk (HR 1.26 and 1.25, respectively). No significant differences for wrist, ankle, or arm fractures after BMI adjustment.
Confidence Level
Moderate-to-high confidence. Large prospective cohort with long follow-up, objective outcome ascertainment, and adjustment for many confounders. However, observational design limits causal inference, and there are potential residual confounders and measurement errors in dietary intake.
Study Flags
Red Flags
- •Observational design cannot establish causation
- •Potential residual confounding
- •Self-reported dietary intake may have measurement error
Surprising Findings
Even after adjusting for calcium and protein intake, vegans still had a 30% higher risk of total fractures.
Common wisdom suggests that supplementing calcium and eating enough protein should mitigate bone risks, but this study shows it's not sufficient.
Practical Takeaways
If you're vegan or vegetarian, ensure adequate intake of bone-supporting nutrients: calcium, vitamin D, protein, vitamin B12, and possibly omega-3s. Consider periodic bone density tests if you're over 50 or have other risk factors.
RCT reviewsReviews of RCTs (Meta-analyses)
Max 100Randomized TrialsRandomized Trials
Max 90Reviews of Cohort StudiesReviews of Cohort Studies
Max 85Cohort StudiesCohort Studies
Max 72Reviews of Case-Control StudiesReviews of Case-Control Studies
Max 63Case-Control StudiesCase-Control Studies
Max 58Cross-Sectional & Case SeriesCross-Sectional & Case Series
Max 50Expert OpinionExpert Opinion
Max 567 / 100
Probability of being correct
Groups of people are followed over time to see who develops an outcome. Strong for identifying risk factors and associations, but cannot prove causation as firmly as RCTs.
Human Cohort Study
Subject
Moderate probability
on the GRADE evidence scale
This study is like watching a big group of people over many years to see who breaks bones. It found that people who don't eat meat, especially vegans, have more broken bones than meat eaters. But this doesn't prove that not eating meat causes broken bones—it could be something else about those people, like being thinner or having lower calcium. So we can say they are linked, but we can't say one causes the other.
Strengths
- Prospective design with long follow-up (average 17.6 years)
- Large sample size (n=54,898)
- Objective outcome ascertainment via hospital records and death certificates
Weaknesses
- Observational design, cannot establish causation
- Self-reported diet may lead to misclassification
- Residual confounding possible despite adjustments
Methodology
Evidence Keywords
Statistical Reporting
Not medical advice. For informational purposes only. Always consult a healthcare professional. Terms
Researchers in the UK followed over 54,000 people for almost 18 years to see if people who don't eat meat have more broken bones. They found that vegans had more broken bones overall, especially hip fractures, compared to meat eaters. Fish eaters and vegetarians also had slightly more hip fractures. This doesn't prove that these diets cause fractures, but it suggests they might be linked.
Research results
Vegans had about 43% more total fractures and 131% more hip fractures than meat eaters. Fish eaters and vegetarians had about 25% more hip fractures. These numbers were adjusted for factors like weight, smoking, and activity.
What this means - more context
For a human, this means that if 1,000 vegans are followed for 10 years, about 15 more of them will have a hip fracture compared to 1,000 meat eaters. For fish eaters and vegetarians, it's about 3 more hip fractures per 1,000 people over 10 years.
To examine the risks of total and site-specific fractures in vegetarians, vegans, fish eaters, and meat eaters in a large UK prospective cohort.
In the EPIC-Oxford study with 54,898 participants and 17.6 years of follow-up, vegans had 43% higher risk of total fractures (HR 1.43, 95% CI 1.20-1.70) and 2.31 times higher risk of hip fractures (HR 2.31, 95% CI 1.66-3.22) compared to meat eaters. Fish eaters and vegetarians had 25-26% higher hip fracture risk. Associations were partially explained by BMI, calcium, and protein intake but remained significant for vegans. The study has corrections; readers should check for updated information.
Methods Used
Prospective cohort study using EPIC-Oxford data. 54,898 participants (29,380 meat eaters, 8,037 fish eaters, 15,499 vegetarians, 1,982 vegans). Diet groups assessed at baseline and follow-up. Outcomes ascertained via hospital records and death certificates. Multivariable Cox regression adjusted for lifestyle and sociodemographic factors, with and without BMI adjustment.
Main Finding
Compared to meat eaters, vegans had higher risks of total fractures (HR 1.43, 95% CI 1.20-1.70), hip fractures (HR 2.31, 95% CI 1.66-3.22), leg fractures (HR 2.05, 95% CI 1.23-3.41), and vertebral fractures (HR 2.42, 95% CI 2.31-4.48) after adjustment for BMI and confounders. Fish eaters and vegetarians had increased hip fracture risk (HR 1.26 and 1.25, respectively). No significant differences for wrist, ankle, or arm fractures after BMI adjustment.
Confidence Level
Moderate-to-high confidence. Large prospective cohort with long follow-up, objective outcome ascertainment, and adjustment for many confounders. However, observational design limits causal inference, and there are potential residual confounders and measurement errors in dietary intake.
Study Flags
Red Flags
- •Observational design cannot establish causation
- •Potential residual confounding
- •Self-reported dietary intake may have measurement error
Surprising Findings
Even after adjusting for calcium and protein intake, vegans still had a 30% higher risk of total fractures.
Common wisdom suggests that supplementing calcium and eating enough protein should mitigate bone risks, but this study shows it's not sufficient.
Practical Takeaways
If you're vegan or vegetarian, ensure adequate intake of bone-supporting nutrients: calcium, vitamin D, protein, vitamin B12, and possibly omega-3s. Consider periodic bone density tests if you're over 50 or have other risk factors.
RCT reviewsReviews of RCTs (Meta-analyses)
Max 100Randomized TrialsRandomized Trials
Max 90Reviews of Cohort StudiesReviews of Cohort Studies
Max 85Cohort StudiesCohort Studies
Max 72Reviews of Case-Control StudiesReviews of Case-Control Studies
Max 63Case-Control StudiesCase-Control Studies
Max 58Cross-Sectional & Case SeriesCross-Sectional & Case Series
Max 50Expert OpinionExpert Opinion
Max 567 / 100
Probability of being correct
Groups of people are followed over time to see who develops an outcome. Strong for identifying risk factors and associations, but cannot prove causation as firmly as RCTs.
Human Cohort Study
Subject
Moderate probability
on the GRADE evidence scale
This study is like watching a big group of people over many years to see who breaks bones. It found that people who don't eat meat, especially vegans, have more broken bones than meat eaters. But this doesn't prove that not eating meat causes broken bones—it could be something else about those people, like being thinner or having lower calcium. So we can say they are linked, but we can't say one causes the other.
Strengths
- Prospective design with long follow-up (average 17.6 years)
- Large sample size (n=54,898)
- Objective outcome ascertainment via hospital records and death certificates
Weaknesses
- Observational design, cannot establish causation
- Self-reported diet may lead to misclassification
- Residual confounding possible despite adjustments
Methodology
Evidence Keywords
Statistical Reporting
Scoring
How strong is this study?
This is a very big and long study, which is good. They followed almost 55,000 people for about 17 years and checked hospital records for fractures, which is reliable. But it's not a perfect experiment—the people chose what to eat, so there might be other differences. The study tried to adjust for many things, but we can't be sure everything is accounted for. So it gives strong clues, but not absolute proof.
75 / 100
- COI disclosure+40/40
- Data availability+35/35
- Code availabilitycode not shared
38 / 100
- Randomizationnot randomized
- Blindingblinding unclear
- Control groupno control group
- Sample size (n=54898)+20/20
- Follow-up+10/10
100 / 100
77 / 100
- P-values+15/15
- Effect size+20/20
- Confidence intervals+15/15
- Pre-registrationnot pre-registered
Each component is scored out of 100 and then capped by the study design — a case series cannot reach the ceiling a randomised trial can, however well it is reported.
Where it sits
RCT reviewsReviews of RCTs (Meta-analyses)
Max 100Randomized TrialsRandomized Trials
Max 90Reviews of Cohort StudiesReviews of Cohort Studies
Max 85Cohort StudiesCohort Studies
Max 72Reviews of Case-Control StudiesReviews of Case-Control Studies
Max 63Case-Control StudiesCase-Control Studies
Max 58Cross-Sectional & Case SeriesCross-Sectional & Case Series
Max 50Expert OpinionExpert Opinion
Max 567 / 100
Probability of being correct
Groups of people are followed over time to see who develops an outcome. Strong for identifying risk factors and associations, but cannot prove causation as firmly as RCTs.
This design cannot establish causation — the findings describe an association, not a cause. Observational cohort study cannot establish cause-effect relationships. Residual confounding, selection bias, and reverse causation cannot be ruled out. Diet was self-reported and may have misclassification. The association may be due to lifestyle factors or other unmeasured confounders.
COI Unknown
Could not determine conflict of interest status
No funding or conflict of interest information is provided in the given text; the study appears to be an academic observational study.
The text provided does not include declarations on funding or conflicts. Since the study is from a large academic cohort, it may have received public grants, but this is not mentioned.