Is eating plant-based bad for your bones?

Vegans consistently have lower bone mineral density than meat-eaters, and so do vegetarians, though to a lesser extent. In the large EPIC-Oxford study, vegans also showed a demonstrably higher risk of bone fractures. A meta-analysis of more than 243,000 participants found that people following a plant-based diet had more than twice the rate of osteoporosis in the lumbar spine (the lower back), although the results of the individual studies varied considerably. The risk of hip osteoporosis in that same analysis was not statistically significant.

The core of the problem lies with a handful of nutrients. Vegans structurally consume less calcium, vitamin D, vitamin B12 and iodine than meat-eaters. These are precisely the substances that bones need. Those who also eat little protein miss an additional protective factor: higher protein intake is associated with fewer bone fractures, but that effect disappears when calcium intake is simultaneously too low.

The longer you have been eating vegan without paying attention to this, the more the risk increases. After ten or more years of plant-based eating, the risk of osteoporosis is measurably higher, including in the hip. Vegans who do not use fortified products and do not take supplements face the clearest danger of deficiencies.

Not every plant-based eating pattern is the same. A Mediterranean diet, which contains many plants but also fish, dairy and fermented products, is actually linked to a lower risk of hip fractures and is recommended in guidelines for the prevention of osteoporosis. The issue is therefore not plant-based eating in itself, but whether you are getting the critical nutrients. If, as a vegan, you actively ensure sufficient calcium, vitamin D, vitamin B12 and protein, through fortified foods or targeted supplementation, you can considerably reduce the risk.