Risk of fractures may be higher if you follow vegan, vegetarian or pescetarian diet, says study
Vegans and vegetarians need to focus on maintaining a healthy BMI and including proper calcium and protein supplements in their diets to prevent fracture risks
It is common knowledge now that as you age, your bone mineral density naturally declines and certain stages of life — like menopause — can even speed up bone density loss. These changes inevitably increase your risk of getting bone diseases and fractures, which can often have a debilitating effect on your quality of life and overall health. This is the reason why preventing bone mineral density loss, as much as possible, is necessary.
Nutrition is one of the key modifiable factors through which bone health can be regulated. Calcium and protein are two of the main nutrients associated with bone health. However, certain dietary patterns run the risk of not getting enough of these nutrients. A study published in Nutrition Reviews in 2019 found that those who follow a vegetarian (plant-based) or vegan (complete elimination of animal-based foods) diet usually have higher rates of fractures. Many other studies suggest that this is because these dietary patterns may have inadequate intakes of calcium and protein.
A new study published in BMC Medicine is the first to take a more comprehensive look at these dietary patterns and their associated risk of total and site-specific fractures.
Vegans, vegetarians, pescetarians and non-vegetarians
To understand how fracture risk changes according to diet pattern, the researchers behind this study collected data from 54,898 participants of the EPIC-Oxford study between 1993 and 2001, and collected follow-up data from around 2010 until mid-2016. The participants were categorised into four diet groups:
- Meat-eaters or non-vegetarians (29,380)
- Fish eaters or pescetarians (8,037)
- Vegetarians (15,499)
- Vegans (1,982)
Using hospital records or death certificates apart from diet data, the researchers estimated the risk of total and site-specific fractures among these participant groups. In site-specific fractures, they evaluated the risk of arm, wrist, hip, leg, ankle, clavicle, rib and vertebrae fractures. Over an average of 17.6 years, the researchers observed a total of 3,941 cases of fractures, 566 arm fractures, 899 wrist fractures, 945 hip fractures, 366 leg fractures, 520 ankle fractures and 467 other main site fractures.
Risks of total and site-specific fractures
The researchers observed that vegetarians and vegans had a higher risk of total fractures than non-vegetarians. Given that vegetarians and vegans usually tend to have lower BMI, and many also take dietary supplements of calcium and plant-proteins to make up for deficiencies, the researchers further adjusted their evaluation accordingly. Even then, the risks of total fractures remained significantly high for vegans and vegetarians.
When it comes to site-specific fractures, the findings were more varied. After adjusting for socio-economic factors that affect nutrition, lifestyle habits and body mass index (BMI) of the participants, the researchers found that the risks of hip fracture were higher in fish eaters, vegetarians and vegans. Vegans were also found to have higher risks of leg, clavicle, rib and vertebral fractures than meat-eaters.
No significant differences in risks between diet groups were observed for sites like arms, wrists or ankles, although a higher risk of arm fractures was observed in both vegetarians and vegans before BMI adjustments were made. The study also confirmed that postmenopausal women (especially those who were vegan) and participants who had low physical activity levels, lower BMI and were above the age of 50 years had an increasing risk of fractures with age.
The researchers concluded that those who had a vegan diet were at the highest risk of fractures, no matter what the site. This, they explained, was mostly due to the low BMI that most vegans have, which prevents fat accumulation and therefore reduces cushioning around the main fracture sites, especially the hips. Muscle strength, which is determined by protein intake and exercise levels, is another major factor in fractures and the study suggests that vegans and vegetarians both have lower lean muscle mass and grip strength. This could also lead to the higher risks of fractures in these groups.
In conclusion, vegans and vegetarians need to focus on maintaining a healthy BMI and including proper calcium and protein supplements in their diets to prevent fracture risks.
For more information, read our article on Fractured bones.
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