{"id":27812,"date":"2026-04-14T08:33:00","date_gmt":"2026-04-14T06:33:00","guid":{"rendered":"https:\/\/www.carnisostenibili.it\/?p=27812"},"modified":"2026-04-14T11:51:50","modified_gmt":"2026-04-14T09:51:50","slug":"plant-based-diets-and-fracture-risk","status":"publish","type":"post","link":"https:\/\/www.carnisostenibili.it\/en\/plant-based-diets-and-fracture-risk\/","title":{"rendered":"Plant-Based Diets and Fracture Risk"},"content":{"rendered":"\n

Plant-based diets, while perceived as healthy, raise emerging concerns, including a possible increased risk of bone fractures.<\/em><\/p>\n\n\n\n

In recent years, plant-based diets<\/strong> (primarily vegetarian and vegan) have entered the public debate as synonymous with healthy eating<\/strong>. However, when we move beyond the prevailing narrative and look at individual clinical outcomes, critical areas emerge that cannot be ignored<\/strong>. One of these concerns is bone health<\/strong>, particularly the risk of fractures<\/strong>.<\/p>\n\n\n\n

The reference point remains the landmark EPIC-Oxford study<\/strong>, published in 2020 in BMC Medicine by Tong et al. (“Vegetarian and vegan diets and risks of total and site-specific fractures: results from the prospective EPIC-Oxford study<\/em><\/a>“). This is a prospective cohort of nearly 55,000 British adults followed for approximately 18 years<\/strong>. The results are clear: compared to meat eaters, vegetarians and pescetarians<\/strong> (those who exclude meat and poultry but consume fish) have a moderately increased risk of fractures, while vegans have more than double the risk of hip fractures<\/strong>. Vegans also have an increased risk of total fractures and fractures of some specific sites, such as the leg and vertebrae.<\/p>\n\n\n\n


Vegan diets: even careful planning may not fully mitigate bone health risks<\/em><\/strong><\/p>\n\n\n\n

This finding remains highly significant, even after adjusting for important factors such as BMI, calcium and protein intake. This point is crucial because it refutes a widespread simplistic explanation: “It’s not the vegan diet itself; it’s just that they eat poorly. “The fact that these subjects still show a higher risk of fracture after adjusting for these factors calls into question the assumption that plant-based diets are nutritionally equivalent to omnivorous models if “well-planned<\/strong>. “<\/p>\n\n\n\n

Evidence indicates that the problem isn’t limited to individual deficiencies, but concerns the overall nutritional makeup of these diets<\/strong>, particularly vegan ones, and their long-term impact on bone health<\/strong>. In other words, the data suggest that the plant-based dietary pattern may have inherent limitations for maintaining skeletal integrity, and that other factors are at play, related to the overall dietary pattern rather than just individual nutrients.<\/p>\n\n\n\n


Fracture and osteoporosis risk in vegetarians compared with omnivores<\/em><\/strong><\/p>\n\n\n\n

In subsequent years, these findings have not been refuted<\/strong>. On the contrary, a new meta-analysis published in 2025 in Nutrition Reviews<\/strong> (Ballarin et al., “Vegetarian and Vegan Diets and the Risk of Hip Fracture in Adults: A Systematic Review and Meta-analysis<\/em><\/a>“)\u00a0t<\/strong><\/span>hat combined four large cohort studies totalling over 500,000 participants<\/strong> confirmed these findings. Vegetarians show an increased risk of hip fracture of approximately 25%, while vegans have an increase of approximately 75% compared to omnivores<\/strong>.<\/p>\n\n\n\n

This evidence was further confirmed by another very recent, large-scale meta-analysis published in 2025 in Clinical Nutrition<\/strong> (Zheng et al., “Plant-based diet and risk of osteoporosis: A systematic review and meta-analysis<\/em><\/a>“). The review included 20 studies with over 243,000 participants<\/strong>, comparing vegetarians and vegans<\/strong> with omnivorous dieters. The results show that plant-based diets are associated with a significantly increased risk of lumbar spine osteoporosis<\/strong>, with more pronounced signs in vegans and subjects who have followed such diets for more than 10 years.<\/p>\n\n\n\n

This increased fracture risk<\/strong> has a biological basis. The meta-analysis published in Nutrition Reviews in 2019 (Iguacel I et al. “Veganism, vegetarianism, bone mineral density, and fracture risk: a systematic review and meta-analysis<\/em><\/a>“) had already clearly shown that vegetarians and vegans have lower bone mineral density<\/strong>, especially in the lumbar spine and femoral neck. The differences become clinically relevant in the long term, especially with advancing age<\/strong>.<\/p>\n\n\n\n

Ignoring these findings is not compatible with an evidence-based medical approach.<\/em><\/strong><\/p>\n\n\n\n

From a nutritional standpoint, the explanations are far from speculative<\/strong>. Scientific reviews on bone mineral density, including an Italian review published in Frontiers in Endocrinology in 2022, show that in plant-based diets, particularly vegan ones, calcium intake tends to be lower<\/strong> if fortified foods are not systematically used. Vitamin D is often insufficient<\/strong>. Protein intake, especially in less-structured versions of the diet, may be inadequate to maintain bone mass. Added to this is a lower average BMI, which represents an independent risk factor for hip fractures<\/strong>.<\/p>\n\n\n\n

Finally, deficiencies of vitamin B12, zinc, selenium and other nutrients involved in bone remodelling processes<\/strong> and often critical in exclusively plant-based diets should not be overlooked (see also, for this purpose, the systematic review published in Nutrients in 2021, “Nutrient Intake and Status in Adults Consuming Plant-Based Diets Compared to Meat-Eaters: A Systematic Review<\/em><\/a>“).<\/p>\n\n\n\n

Overall, all available evidence indicates that plant-based diets, especially vegan ones, are not neutral with respect to skeletal health<\/strong>. On the contrary, they are consistently associated with an increased risk of fractures, particularly hip fractures<\/strong>. This finding must be taken into account in clinical practice, especially in older individuals, postmenopausal women, and those with existing risk factors for osteoporosis.<\/p>\n\n\n\n

Ignoring or downplaying these findings for ideological reasons is not compatible with an evidence-based medical approach<\/strong>.<\/p>\n","protected":false},"excerpt":{"rendered":"

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