Plant-based diets and bone health

Bone health needs special consideration on a plant-based diet.

  1. The cause of fractures (trauma or fragility) is not known in all three studies, although hip fractures are usually due to osteoporosis.
  2. None of the studies have assessed bone mineral density. However, a prior systematic review and meta-analysis of bone mineral density and fracture risk in vegetarian and vegans (20 studies, 37, 134 participants) found that vegetarians and vegans had lower bone mineral density and an increased rate of fracture.
  3. Both the UK studies recruited vegetarians and vegans in the 1990’s when knowledge about healthy plant-based diets was not so accessible or available, fortification of plant-based products was not so common place and use of supplementation with vitamin B12 and D not widespread.
  4. The exact reason for the increased risk of fractures in vegetarians and vegans is not clear. It is certainly not caused by dairy deficiency given that the most recent paper highlights an increased risk in vegetarians who were consuming dairy. One proposed mechanism is that those on a plant-based diet have lower levels of the growth hormone IGF-1, which is an advantage when it comes to cancer prevention, but may be one reason for the observed increase in fracture rates.
  1. Bone health requires particular attention for those on a plant-based diet, especially in women.
  2. It is important to ensure a plant-based diet is healthy and meeting your calorie and nutrient requirements. For bone health, ensure you are consuming sufficient nutrients protein, calcium, vitamin B12 and vitamin D. A healthy plant-based diet is one that is composed of a variety of fruit, vegetables, whole grains and beans in roughly equal proportions with a small portion of nuts and seeds daily whilst minimising processed/packaged foods. It is helpful to incorporate fortified foods and drinks such as soya milk, yogurt and calcium-set tofu.
  3. On a vegan diet, vitamin B12 supplementation is essential and depending on exposure to the sun, vitamin D supplementation may be important too.
  4. Ensure you are consuming enough protein, especially as you age. Include protein-rich foods, such as beans, lentils, soya, nuts and seeds. The addition of plant-based meat alternatives products made with seitan, Quorn or soya protein may be a useful way of ensuring adequate protein consumption, but be sure to choose the healthiest product you can.
  5. Avoid or minimise dietary components that are known to negatively impact bone health including alcohol and tobacco smoking, caffeine, fizzy drinks and added salt.
  6. Weight bearing physical activity and muscle strengthening exercise are vitally important for bone health throughout the lifespan and may need to be emphasised more for those on a 100% plant-based diet.
  7. Don’t be underweight, especially if you are a woman, and it may also be beneficial to aim for the middle of the BMI range.

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Consultant Haematologist and Lifestyle Medicine Physician. Founder and Director of Plant-based health professionals UK.

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Shireen Kassam

Consultant Haematologist and Lifestyle Medicine Physician. Founder and Director of Plant-based health professionals UK.