Diets
plant-based diet increases risk of low bone mineral density and fracture
In plain terms: Do vegans have weaker bones and more fractures (especially hip)?
Part of: 🥗 plant-based diet
Yes, modestly — vegans/vegetarians show slightly lower bone density and higher hip-fracture risk, largely mediated by low calcium/protein/B12 and lower BMI rather than plant foods per se.
Evidence ladder
How far up the ladder this claim has climbed. A high consensus on a low rung means "consistent so far," not "proven in people."
Top evidence so far: All trials, pooled (Meta-analysis)
How the studies fall
The evidence (9)
| Source | Grade | Stance | Quality | Finding |
|---|---|---|---|---|
| Iguacel 2019 · Nutr Rev | meta-analysis | supports | moderate | Meta-analysis: vegetarians and especially vegans had lower BMD and higher total fracture risk than omnivores. |
| Appleby 2007 · Eur J Clin Nutr | observational | supports | moderate | EPIC-Oxford: vegans had higher fracture rates than meat-eaters, attenuated after adjusting for calcium intake. |
| Ho-Pham 2009 · Osteoporos Int | observational | contradicts | moderate | Buddhist-nun vegans had lower calcium/protein intake but no adverse effect on BMD vs omnivores. |
| Kraselnik 2024 · Curr Nutr Rep | observational | mixed | moderate | Review: classic BMD deficit is small and confounded by BMI/calcium/protein/B12; well-planned supplemented plant-based diets may mitigate fracture risk. |
| Tong 2020 · BMC Med | observational | supports | high | Prospective EPIC-Oxford cohort: vegans had 43% higher total and 2.3x higher hip fracture risk vs meat-eaters. |
| Hsu 2020 · Curr Opin Endocrinol Diabetes Obes | observational | mixed | moderate | Review notes plausible adverse bone effects of plant-based diets but confounding limits causal inference. |
| Sotos-Prieto 2024 · JAMA Netw Open | observational | mixed | high | NHS cohort: overall plant-based diet not linked to hip fracture, but LOW-quality plant-based diets raised risk while healthful ones did not — quality matters. |
| Galchenko 2024 · Front Nutr | observational | supports | moderate | Cross-sectional study: vegans showed lower bone mineral density parameters linked to nutrient status. |
| Ballarin 2025 · Nutr Rev | meta-analysis | supports | moderate | Systematic review/meta-analysis: vegetarian and vegan diets associated with increased hip-fracture risk vs omnivores. |
Disagree, or know a study we missed?
We grade by evidence, not opinions. The way to weigh in is to point us to a study we haven't cited (check the evidence table above first), or to flag a problem with one we have. Every submission is reviewed; if it holds up, the grade updates and shows in Science Changes Its Mind.
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Educational only, not medical advice. Grades and scores reflect published evidence weighted by study design and quality; see the methodology.