Takeaway
- 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).
- vertebral fracture (aHR, 2.42; 95% CI, 2.31-4.48).
- 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.
Limitations
- The cause of fracture or calcium that was taken in supplement form was not considered.
- Limited generalisability.
This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.
