Cited by 222Bone health and osteoporosis researchNutritional Studies and DietVitamin D Research Studies

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Veganism, vegetarianism, bone mineral density, and fracture risk: a systematic review and meta-analysis

Iguacel, Isabel, Miguel-Berges, María L, Gómez-Bruton, Alejandro, Moreno, Luis A, Julián, Cristina·2019·Nutrition Reviews

DOI 10.1093/nutrit/nuy045

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Abstract

Context: The numbers of vegans and vegetarians have increased in the last decades. However, the impact of these diets on bone health is still under debate. Objective: This systematic review and meta-analysis sought to study the impact of vegetarian and vegan diets on bone mineral density (BMD) and fracture risk. Data Sources: A systematic search was conducted of PubMed, Scopus, and Science Direct, covering the period from the respective start date of each database to November 2017. Data Extraction: Two investigators evaluated 275 studies against the inclusion criteria (original studies in humans, written in English or Spanish and including vegetarian or vegan diets and omnivorous diets as factors with BMD values for the whole body, lumbar spine, or femoral neck and/or the number of fractures as the outcome) and exclusion criteria (articles that did not include imaging or studies that included participants who had suffered a fracture before starting the vegetarian or vegan diet). The quality assessment tool for observational cohort and cross-sectional studies was used to assess the quality of the studies. Results: Twenty studies including 37 134 participants met the inclusion criteria. Compared with omnivores, vegetarians and vegans had lower BMD at the femoral neck and lumbar spine and vegans also had higher fracture rates. Conclusions: Vegetarian and vegan diets should be planned to avoid negative consequences on bone health. Systematic Review Registration: PROSPERO registration no. CRD42017055508.

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Higgins, J. P. T., Altman, D. G., Gotzsche, P. C., Juni, P., Moher, D., Oxman, A. D., Savovic, J., Schulz, K. F., Weeks, L., Sterne, J. A. C., et al. (2011) · BMJ · doi:10.1136/bmj.d5928 · Cited by 33,817
The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gotzsche, P. C., Ioannidis, J. P. A., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009) · BMJ · doi:10.1136/bmj.b2700 · Cited by 17,648
Operating characteristics of a rank correlation test for publication bias
Begg, C. B., & Mazumdar, M. (1994) · Biometrics · doi:10.2307/2533446 · Cited by 16,955
The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations
Hutton, B., Salanti, G., Caldwell, D. M., Chaimani, A., Schmid, C. H., Cameron, C., Ioannidis, J. P. A., Straus, S., Thorlund, K., Jansen, J. P., et al. (2015) · Annals of Internal Medicine · doi:10.7326/m14-2385 · Cited by 8,269
Epidemiology and outcomes of osteoporotic fractures
Cummings, S. R., & Melton, L. J. (2002) · The Lancet · doi:10.1016/s0140-6736(02)08657-9 · Cited by 3,821
Comparison of two methods to detect publication bias in meta-analysis.
Peters, J. L. (2006) · JAMA · doi:10.1001/jama.295.6.676 · Cited by 2,278
A comparison of direct vs. self‐report measures for assessing height, weight and body mass index: a systematic review
Gorber, S. C., Tremblay, M., Moher, D., & Gorber, B. (2007) · Obesity Reviews · doi:10.1111/j.1467-789x.2007.00347.x · Cited by 1,945
Perspective how many women have osteoporosis?
Melton, L. J., Chrischilles, E. A., Cooper, C. C., Lane, A. W., & Riggs, B. L. (1992) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.5650070902 · Cited by 1,400
Position of the Academy of Nutrition and Dietetics: Vegetarian Diets
Melina, V., Craig, W., & Levin, S. (2016) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2016.09.025 · Cited by 1,360
Assessment of fracture risk
Kanis, J. А., Borgström, F., Laet, C. E. D. H. D., Johansson, H., Johnell, O., Jönsson, B., Odén, A., Zethraeus, N., Pfleger, B., & Khaltaev, N. (2004) · Osteoporosis International · doi:10.1007/s00198-004-1780-5 · Cited by 1,257

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UK clinical guideline for the prevention and treatment of osteoporosis
Gregson, C. L., Armstrong, D. J., Bowden, J., Cooper, C., Edwards, J., Gittoes, N. J. L., Harvey, N., Kanis, J., Leyland, S., Low, R., et al. (2022) · Archives of Osteoporosis · doi:10.1007/s11657-022-01061-5 · Cited by 593
“Whilst there are inconsistencies in the evidence base for the associations between vegetarian and vegan diets and musculoskeletal health, consumption of a vegetarian or vegan diet has been associated with lower BMD at the lumbar spine and hip than an omnivore diet, and a vegan diet has been associated with higher frac…”
Background
Nutrient Intake and Status in Adults Consuming Plant-Based Diets Compared to Meat-Eaters: A Systematic Review
Neufingerl, N., & Eilander, A. (2021) · Nutrients · doi:10.3390/nu14010029 · Cited by 484
“Our findings are in line with two recent systematic reviews and meta-analysis, which found that vegetarians and vegans had lower lumbar spine, femoral neck, and whole-body BMDs than omnivores [74,75].”
Result
The Safe and Effective Use of Plant-Based Diets with Guidelines for Health Professionals
Craig, W. J., Mangels, A. R., Fresán, U., Marsh, K. A., Miles, F. L., Saunders, A. V., Haddad, E. H., Heskey, C. E., JOHNSTON, P. K., Larson‐Meyer, E., et al. (2021) · Nutrients · doi:10.3390/nu13114144 · Cited by 379
Nutritional intake and bone health
Rizzoli, R., Biver, E., & Brennan‐Speranza, T. C. (2021) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(21)00119-4 · Cited by 318
Association of Healthful Plant-based Diet Adherence With Risk of Mortality and Major Chronic Diseases Among Adults in the UK
Thompson, A. S., Tresserra-Rimbau, A., Karavasiloglou, N., Jennings, A., Cantwell, M., Hill, C., Perez-Cornago, A., Bondonno, N. P., Murphy, N., Rohrmann, S., et al. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.4714 · Cited by 203
Vegetarian Diet: An Overview through the Perspective of Quality of Life Domains
Hargreaves, S. M., Raposo, A., Saraiva, A., & Zandonadi, R. P. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18084067 · Cited by 236
The Role of Macronutrients, Micronutrients and Flavonoid Polyphenols in the Prevention and Treatment of Osteoporosis
Martiniaková, M., Babikova, M., Mondočková, V., Bláhová, J., Kováčová, V., & Omelka, R. (2022) · Nutrients · doi:10.3390/nu14030523 · Cited by 184
“[49] determined lower BMD in the femoral neck and lumbar spine of vegetarians and vegans compared to omnivores, and on the other hand, no significant differences between animal and plant”
Background
Vegetarianism and veganism compared with mental health and cognitive outcomes: a systematic review and meta-analysis
Iguacel, I., Huybrechts, I., Moreno, L. A., & Michels, N. (2020) · Nutrition Reviews · doi:10.1093/nutrit/nuaa030 · Cited by 152
Postbiotics: metabolites and mechanisms involved in microbiota-host interactions
Peluzio, M. D. C. G., Martinez, J. A., & Milagro, F. I. (2021) · Trends in Food Science & Technology · doi:10.1016/j.tifs.2020.12.004 · Cited by 139
The importance of vitamin B12 for individuals choosing plant-based diets
Niklewicz, A., Smith, A. D., Smith, A. G., Holzer, A., Klein, A. A., McCaddon, A., Molloy, A. M., Wolffenbuttel, B. H. R., Nexø, E., McNulty, H., et al. (2022) · European Journal of Nutrition · doi:10.1007/s00394-022-03025-4 · Cited by 135
“A vegan diet is associated with higher fracture risk, likely due to low BMI (Body Mass Index) and other nutrient deficiencies [35, 36].”
Background
Exploring Benefits and Barriers of Plant-Based Diets: Health, Environmental Impact, Food Accessibility and Acceptability
Viroli, G., Kalmpourtzidou, Α., & Cena, H. (2023) · Nutrients · doi:10.3390/nu15224723 · Cited by 135
“Regarding nutrient adequacy, subjects following a vegetarian or vegan dietary patterns are at risk of vitamin B12, D, calcium, iron, niacin (B3), iodine, selenium and zinc deficiencies [55–59].”
Evidence of a vegan diet for health benefits and risks – an umbrella review of meta-analyses of observational and clinical studies
Selinger, E., Neuenschwander, M., Koller, A., Gojda, J., Kühn, T., Schwingshackl, L., Barbaresko, J., & Schlesinger, S. (2023) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2022.2075311 · Cited by 114
“…systematic reviews with meta-analyses (Dinu et al. 2017; Lopez et al. 2019; Yokoyama, Levin, and Barnard 2017; Huang et al. 2016; Rees et al., 2021; Iguacel et al. 2019; Lee and Park 2017; Li et al. 2020; Benatar and Stewart 2018; Picasso et al. 2019; Chiavaroli et al. 2018; Craddock et al. 2019;…”
Background
Should dietary guidelines recommend low red meat intake?
Leroy, F., & Cofnas, N. (2019) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2019.1657063 · Cited by 130
“…found either that meat intake has no association with mortality/morbidity, or that meat restriction is association with various negative health outcomes (e.g., Key et al., 2009; Burkert et al., 2014; Kwok et al., 2014; Lippi et al., 2015; Hur et al., 2018; Iguacel et al., 2018; Yen et al., 2018).”
Background
The 2024 UK clinical guideline for the prevention and treatment of osteoporosis
Gregson, C. L., Armstrong, D., Avgerinou, C., Bowden, J., Cooper, C. C., Douglas, L., Edwards, J., Gittoes, N. J. L., Harvey, N. C., Kanis, J. A., et al. (2025) · Archives of Osteoporosis · doi:10.1007/s11657-025-01588-3 · Cited by 136
“…hip in one RCT, and in observational studies, has been associated with a reduced risk of hip fractures [152, 153]; (Evidence levels Ib and IIa); however, in a meta-analysis of 30 interventional studies, no significant effects of protein supplementation on BMD were seen [153]; (Evidence level Ia).”
MILK Symposium review: The importance of milk and dairy foods in the diets of infants, adolescents, pregnant women, adults, and the elderly
Givens, D. I. (2020) · Journal of Dairy Science · doi:10.3168/jds.2020-18296 · Cited by 122
“Also, a recent systematic review and meta-analysis of the associations between vegan and vegetarian diets and bone health gives further evidence on the chronic effect of diets containing low or zero milk and dairy products (Iguacel et al., 2019).”
Background
Emerging factors affecting peri‐implant bone metabolism
Ínsua, Á., Galindo‐Moreno, P., Miron, R. J., Wang, H., & Monje, A. (2023) · Periodontology 2000 · doi:10.1111/prd.12532 · Cited by 119
A Perspective on the Transition to Plant-Based Diets: a Diet Change May Attenuate Climate Change, but Can It Also Attenuate Obesity and Chronic Disease Risk?
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“The adequacy of vegetarian and vegan diets in relation to bone fractures was addressed in a recent meta-analysis of 20 observational studies including 37,134 individuals (71).”
Meat and mental health: a systematic review of meat abstention and depression, anxiety, and related phenomena
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“Studies indicate that vegetarian, including vegan, adults have a lower bone mineral density [49] and a higher risk for fractures [50].”
Background
Vegan diet in children and adolescents. Recommendations from the French-speaking Pediatric Hepatology, Gastroenterology and Nutrition Group (GFHGNP)
Lemale, J., Mas, E., Jung, C., Bellaiche, M. M., & Tounian, P. (2019) · Archives de Pédiatrie · doi:10.1016/j.arcped.2019.09.001 · Cited by 99
“studies in adolescents have indicated an increased risk of fracture due to this decrease in BMD, but a recent meta-analysis conducted in adults has confirmed that vegans have an increased risk of fracture [32].”
Result
Dairy products and bone health
Rizzoli, R. (2021) · Aging Clinical and Experimental Research · doi:10.1007/s40520-021-01970-4 · Cited by 112
Dietary Intervention to Improve Blood Pressure Control: Beyond Salt Restriction
Cicero, A. F. G., Veronesi, M., & Fogacci, F. (2021) · High Blood Pressure & Cardiovascular Prevention · doi:10.1007/s40292-021-00474-6 · Cited by 90
Impact of whole dairy matrix on musculoskeletal health and aging–current knowledge and research gaps
Geiker, N. R. W., Mølgaard, C., Iuliano, S., Rizzoli, R., Μanios, Y., van Loon, L. J. C., Lecerf, J. M., Moschonis, G., Reginster, J., Givens, I. D., et al. (2019) · Osteoporosis International · doi:10.1007/s00198-019-05229-7 · Cited by 77
“A recent meta-analysis of observational studies of vegan/ vegetarian diets on bone health reported that a diet free of dairy products was associated with lower BMD at the femoral neck and lumbar spine and higher incidence of fractures in adults [71].”
Background
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Menzel, J., Abraham, K., Stangl, G. I., Ueland, P. M., Obeid, R., Schulze, M. B., Herter‐Aeberli, I., Schwerdtle, T., & Weikert, C. (2021) · Nutrients · doi:10.3390/nu13020685 · Cited by 72
“Scientific evidence suggests that vegans tend to show a healthier lifestyle compared to omnivores, which might have an important impact on BMD [9], i.e., higher levels of physical activity [12], lower smoking rates [12], lower consumption of alcohol [12], and lower BMI.”
BackgroundInfluential
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“[37] has confirmed the significantly lower total body BMD (mean difference—MD −0.”
Background
Vegetarian Dietary Patterns for Adults: A Position Paper of the Academy of Nutrition and Dietetics
Raj, S., Guest, N. S., Landry, M. J., Mangels, A. R., Pawlak, R., & Rozga, M. (2025) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2025.02.002 · Cited by 77
Enhancing the Nutritional Value of Red Meat through Genetic and Feeding Strategies
Juarez, M. M., Lam, S., Bohrer, B. M., Dugan, M. E. R., Vahmani, P., Aalhus, J. L., Juárez, A. A. G., López-Campos, Ó., Prieto, N., & Segura, J. (2021) · Foods · doi:10.3390/foods10040872 · Cited by 64
“However, as studies emerge, more evidence is revealing that the removal of red meat from the human diet may lead to negative health effects, such as lower bone mineral density and higher bone fracture rates [14].”
Background
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Moreno, L. A., Meyer, R. W., Donovan, S. M., Goulet, O., Haines, J., Kok, F. J., & Veer, P. V. (2021) · Advances in Nutrition · doi:10.1093/advances/nmab139 · Cited by 65
“In addition to iron deficiency anemia, vegan/vegetarian diets have been associated with an increased risk of low birth weight (68–71) and impaired neurocognitive health among infants (72–74), increased risk of stroke among adults (75), impaired vision (74), higher rates of depression (76, 77) and (for vegans) reduced…”
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The Belgian Bone Club 2020 guidelines for the management of osteoporosis in postmenopausal women
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“Individuals who follow calorie restriction, intermittent fasting, vege-tarian, or vegan diets should consider dietary sources of calcium and vitamin D and/or supplementation [235,236].”
Background
Intake of micronutrients and fatty acids of vegetarian, vegan, and omnivorous children (1–3 years) in Germany (VeChi Diet Study)
Weder, S., Keller, M., Fischer, M., Becker, K., & Alexy, U. (2021) · European Journal of Nutrition · doi:10.1007/s00394-021-02753-3 · Cited by 61
“In a recent systematic review and meta-analysis of 20 cohort and cross-sectional studies (n = 37,134), VG and VN adults had lower bone mineral densities and VN a higher fracture rate than OM adults [39].”
Background
Nutrient status and growth in vegan children
Sutter, D., & Bender, N. (2021) · Nutrition Research · doi:10.1016/j.nutres.2021.04.005 · Cited by 74
“[16] Iguacel I, Miguel-Berges ML, Gómez-Bruton A, Moreno LA, Julián C.”
Background
Dietary recommendations in the prevention and treatment of osteoporosis
Biver, E., Herrou, J., Larid, G., Legrand, M. A., Gonnelli, S., Annweiler, C., Chapurlat, R. D., Coxam, V., Fardellone, P., Thomas, T., et al. (2022) · Joint Bone Spine · doi:10.1016/j.jbspin.2022.105521 · Cited by 65
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Thorpe, D. L., Beeson, W. L., Knutsen, R., Fraser, G. E., & Knutsen, S. F. (2021) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/nqab095 · Cited by 61
“A recent meta-analysis of fracture outcomes in a small number of cohort studies concluded that vegans had higher fracture rates than omnivores (29), consistent with our findings.”
Result
Partial Replacement of Animal Proteins with Plant Proteins for 12 Weeks Accelerates Bone Turnover Among Healthy Adults: A Randomized Clinical Trial
Itkonen, S. T., Päivärinta, E., Pellinen, T., Viitakangas, H., Risteli, J., Erkkola, M., Lamberg-Allardt, C. J. E., & Pajari, A. (2020) · Journal of Nutrition · doi:10.1093/jn/nxaa264 · Cited by 58
“A recent systematic review and meta-analysis of 20 studies including 37,134 participants showed that vegetarians and vegans had lower lumbar spine and femoral neck bone mineral density and higher fracture risks than omnivores (7).”
Background
The effects of calorie restriction, intermittent fasting and vegetarian diets on bone health
Veronese, N., & Reginster, J. (2019) · Aging Clinical and Experimental Research · doi:10.1007/s40520-019-01174-x · Cited by 59
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“Vegetarian and vegan patterns have been associated with lower bone mineral density and increased fracture risk [58].”
Background
Osteomalacia Is Not a Single Disease
Cianferotti, L. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms232314896 · Cited by 47
“An unbalanced vegan diet is often associated with nutritional deficiencies of various degrees and may be responsible for even severe forms of osteomalacia in both young people and adults [45].”
Background
A Pesco-Mediterranean Diet With Intermittent Fasting
O’Keefe, J. H., Torres-Acosta, N., O’Keefe, E. L., Saeed, I. M., Lavie, C. J., Smith, S. E., & Ros, E. (2020) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2020.07.049 · Cited by 45
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Webster, J., Via, J. D., Langley, C. K., Smith, C., Sale, C., & Sim, M. (2023) · Bone Reports · doi:10.1016/j.bonr.2023.101684 · Cited by 49
Nutritional Considerations for the Vegan Athlete
West, S., Monteyne, A. J., van der Heijden, I., Stephens, F. B., & Wall, B. T. (2023) · Advances in Nutrition · doi:10.1016/j.advnut.2023.04.012 · Cited by 42
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Leite, J. C., Caldeira, S., Watzl, B., & Wollgast, J. (2019) · Global Food Security · doi:10.1016/j.gfs.2019.100342 · Cited by 37
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Baroni, L., Rizzo, G., Galchenko, A. V., Zavoli, M., Serventi, L., & Battino, M. A. (2024) · Foods · doi:10.3390/foods13152398 · Cited by 45
“We found a meta-analysis on bone health [16] with uncertain unfavorable effects, but it was unique, which led us to exclude bone health from the review.”
Background
Veganism and paediatric food allergy: two increasingly prevalent dietary issues that are challenging when co-occurring
Protudjer, J. L. P., & Mikkelsen, A. (2020) · BMC Pediatrics · doi:10.1186/s12887-020-02236-0 · Cited by 35
Association of Dietary Total Antioxidant Capacity with Bone Mass and Osteoporosis Risk in Korean Women: Analysis of the Korea National Health and Nutrition Examination Survey 2008–2011
Kim, D., Han, A., & Park, Y. (2021) · Nutrients · doi:10.3390/nu13041149 · Cited by 35
“However, a recent study found that vegetarians and vegans showed a lower BMD at the femoral neck and lumbar spine compared to non-vegans [49], which might come from the insufficient intake of dietary calcium, vitamin D, and high biological value proteins in the vegan diet [50].”
Result
Rheumatoid arthritis and osteoporosis: a bi-directional Mendelian randomization study
Liu, Y., Liu, Y., Chen, Z., Li, H., & Xiao, T. (2021) · Aging · doi:10.18632/aging.203029 · Cited by 36
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“This can result in lower bone mineral density and a heightened risk of fractures among vegans than in omnivores [144].”
The Effects of Different Dietary Patterns on Bone Health
Liu, X., Wu, Y., Bennett, S., Zou, J., Xu, J., & Zhang, L. (2024) · Nutrients · doi:10.3390/nu16142289 · Cited by 36
“A previous meta-analysis showed that vegetarians had lower femoral neck and lumbar spine BMDs than omnivores [56], and this was confirmed by a subsequent meta-analysis including 20 studies and 37,134 subjects, which found that vegans had a higher risk of fracture than omnivores [57].”
Result
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Feng, W., Wang, X., Huang, D. F., & Lu, A. (2021) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2021.1989374 · Cited by 32
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Brazilian vegetarians diet quality markers and comparison with the general population: A nationwide cross-sectional study
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Effects of vegetarian diet on bone mineral density
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BackgroundResultInfluential
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“In a 2019 meta-analysis including 20 studies and 37,134 participants, vegetarians and vegans had lower bone mineral density at the femoral neck and lumbar spine than omnivores [47].”
Plant-based dietary patterns are associated with lower body weight, BMI and waist circumference in older Australian women
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“A recent systematic review and meta-analysis demonstrated that compared to omnivores, lacto-ovo vegetarians and vegans had significantly lower bone mineral density and vegans had significantly higher fracture risk(52).”
BackgroundResult
Risk of hip fracture in meat-eaters, pescatarians, and vegetarians: results from the UK Women’s Cohort Study
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“The number of vegetarians worldwide is increasing [7], possibly due to accumulating evidence of reduced risks of several chronic diseases, including diabetes [14], ischaemic heart disease, and cancer [15], and a lower environmental footprint of vegetarian diets compared to omnivorous diets [16, 17].”
Background
Dietary Intake and Circulating Amino Acid Concentrations in Relation with Bone Metabolism Markers in Children Following Vegetarian and Omnivorous Diets
Ambroszkiewicz, J., Gajewska, J., Mazur, J., Kuśmierska, K., Klemarczyk, W., Rowicka, G., Strucińska, M., & Chełchowska, M. (2023) · Nutrients · doi:10.3390/nu15061376 · Cited by 28
Risk of hip fracture in meat-eaters, pescatarians, and vegetarians: a prospective cohort study of 413,914 UK Biobank participants
Webster, J., Greenwood, D. C., & Cade, J. E. (2023) · BMC Medicine · doi:10.1186/s12916-023-02993-6 · Cited by 28
“Previous studies have reported slightly lower whole-body and femoral neck BMD, FFM, and muscle strength in vegetarians than in meat-eaters [13, 14].”
BackgroundResult
Effects of Plant-Based Protein Interventions, with and without an Exercise Component, on Body Composition, Strength and Physical Function in Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Stoodley, I. L., Williams, L. M., & Wood, L. G. (2023) · Nutrients · doi:10.3390/nu15184060 · Cited by 29
“While only two studies included in this review measured bone density, other studies and reviews do not indicate that plant or animal protein sources are useful for improving bone density for adults > 18 years old [66–68].”
Strontium combined with bioceramics for osteoporotic bone repair: Oral intake or as a dopant?
Chen, S., Zhao, R., Xing, Z., Shang, T., Yang, X., Zhu, X., & Zhang, X. (2021) · Applied Materials Today · doi:10.1016/j.apmt.2020.100927 · Cited by 27
Protein intake and bone mineral density: Cross‐sectional relationship and longitudinal effects in older adults
Groenendijk, I., Grootswagers, P., Santoro, A., Franceschi, C., Bazzocchi, A., Meunier, N., Caillé, A., Malpuech‐Brugère, C., Białecka-Dębek, A., Pietruszka, B., et al. (2022) · Journal of Cachexia Sarcopenia and Muscle · doi:10.1002/jcsm.13111 · Cited by 29
“Indeed, earlier studies have linked vegetarianism and veganism to increased fracture risk.(30,31) However, there are also reasons to argue that plant protein would lead to increased BMD.”
Background
The Hidden Dangers of Plant-Based Diets Affecting Bone Health: A Cross-Sectional Study with U.S. National Health and Nutrition Examination Survey (NHANES) Data from 2005–2018
Zheng, Y., Wang, J., Wang, Y., Xu, K., & Chen, X. (2023) · Nutrients · doi:10.3390/nu15071794 · Cited by 27
“Additionally, a metaanalysis found that individuals following a plant-based diet exhibited lower BMD and higher rates of fractures in the femoral neck and lumbar spine than those following an omnivorous diet [18].”
BackgroundInfluential
Consumption Patterns and the Nutritional Contribution of Total, Processed, Fresh, and Fresh-Lean Pork to the U.S. Diet
Datlow, L. Y., Leventhal, M., King, J., & Wallace, T. C. (2023) · Nutrients · doi:10.3390/nu15112595 · Cited by 25
Interactions of the microbiome with pharmacological and non-pharmacological approaches for the management of ageing-related musculoskeletal diseases
Papageorgiou, M., & Biver, E. (2021) · Therapeutic Advances in Musculoskeletal Disease · doi:10.1177/1759720x211009018 · Cited by 22
Comparison of human bone mineral densities in subjects on plant-based and omnivorous diets: a systematic review and meta-analysis
Li, T., Li, Y., & Wu, S. (2021) · Archives of Osteoporosis · doi:10.1007/s11657-021-00955-0 · Cited by 24
Differences in Bone Mineral Density between Adult Vegetarians and Nonvegetarians Become Marginal when Accounting for Differences in Anthropometric Factors
Karavasiloglou, N., Selinger, E., Gojda, J., Rohrmann, S., & Kuhn, T. E. (2020) · Journal of Nutrition · doi:10.1093/jn/nxaa018 · Cited by 22
“With our analyses, we intended to find out whether lower BMI and waist circumference may be determinants of lower BMD among vegetarians rather than suboptimal dietary composition with plant-based diets, as suggested by the authors of the recent metaanalysis on plant-based diets and BMD (3).”
BackgroundResultInfluential
Plant-based alternative proteins—are they nutritionally more advantageous?
Tay, W. L. W., Quek, R. Y. C., Lim, J. C. L., Kaur, B., Ponnalagu, S., & Henry, C. J. (2023) · European Journal of Clinical Nutrition · doi:10.1038/s41430-023-01328-1 · Cited by 24
“A key concern with plant-based diets is a reduction in calcium intake due to the lack of dairy products, lower bioavailability in consumed sources, as well as potential anti-nutritional factors by enzyme inhibitors or chelating cofactors [63, 64].”
Background
Plant-based dietary patterns are associated with lower body weight, BMI and waist circumference in older Australian women
Ferguson, J. J. A., Oldmeadow, C. J., Mishra, G. D., & Garg, M. L. (2022) · NOVA (University of Newcastle Australia) · Cited by 21
Innovative approaches to integrating plant-based nutrition in clinical care: a path to better patient outcomes
Arslan, S., Aydın, A., Gerboğa, R., ARSLAN, H. B., Kırbıyık, K. B., Matar, A., Karabıyık, D., & Solak, E. (2024) · Clinical Science of Nutrition · doi:10.62210/clinscinutr.2024.93 · Cited by 20
“129 Calcium is known to be beneficial for bone and muscle health and milk is considered the primary source of calcium.”
Background
Nutritional Assessment of the Symptomatic Patient on a Plant-Based Diet: Seven Key Questions
Plotnikoff, G. A., Dobberstein, L., & Raatz, S. K. (2023) · Nutrients · doi:10.3390/nu15061387 · Cited by 22
Vitamin B12 status is a risk factor for bone fractures among vegans
Pawlak, R. (2021) · Medical Hypotheses · doi:10.1016/j.mehy.2021.110625 · Cited by 20
Bone health: biology and nutrition
Rizzoli, R., & Chevalley, T. (2023) · Current Opinion in Clinical Nutrition & Metabolic Care · doi:10.1097/mco.0000000000000988 · Cited by 18
Sweetener influences plasma concentration of flavonoids in humans after an acute intake of a new (poly)phenol-rich beverage
Agulló, V., Domínguez‐Perles, R., & García‐Viguera, C. (2020) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2020.11.016 · Cited by 18
Bone metabolic biomarker-based diagnosis of type 2 diabetes osteoporosis by support vector machine
Wang, C., Zhang, T., Wang, P., Liu, X., Zheng, L., Miao, L., Zhou, D., Zhang, Y., Hu, Y., Yin, H., et al. (2021) · Annals of Translational Medicine · doi:10.21037/atm-20-3388 · Cited by 17
“During the occurrence and development of DO, complex interactions between multiple factors, such as obesity, cytokines, and advanced glycation end products (AGEs) render BMD inutile as a diagnostic index (11,12).”
Background
The impact of plant-based diets on female bone mineral density
Ma, X., Tan, H., Hu, M., He, S., Zou, L., & Pan, H. (2021) · Medicine · doi:10.1097/md.0000000000027480 · Cited by 18
“In contrast, Iguacel (2019)([11]) indicated that vegetarian and vegan diets should be planned to avoid negative consequences on bone health, because compared with omnivores, vegetarians, and vegans had lower BMD at the femoral neck and lumbar spine and vegans also had higher fracture rates.”
BackgroundResultInfluential
New insights into dairy management and the prevention and treatment of osteoporosis: The shift from single nutrient to dairy matrix effects—A review
Wang, K., Zhao, X., Yang, S., Qi, X., Li, A., & Yu, W. (2024) · Comprehensive Reviews in Food Science and Food Safety · doi:10.1111/1541-4337.13374 · Cited by 18
Nutritional interventions for osteoarthritis: targeting the metabolism-inflammation-oxidative stress axis—clinical evidence and translational practice
Wang, Y., Cao, Z., Gao, Y., Shao, P., Gao, S., Dong, M., Tian, Z., Feng, Y., Xu, J., & Xiang, C. (2025) · Frontiers in Nutrition · doi:10.3389/fnut.2025.1661136 · Cited by 16
Consumption of Phytoestrogens Affects Bone Health by Regulating Estrogen Metabolism
Tomczyk‐Warunek, A., Winiarska‐Mieczan, A., Blicharski, T., Blicharski, R., Kowal, F., Pano, I. T., Tomaszewska, E., & Muszyński, S. (2024) · Journal of Nutrition · doi:10.1016/j.tjnut.2024.05.026 · Cited by 17
Effect of periodic abstinence from dairy products for approximately half of the year on bone health in adults following the Christian Orthodox Church fasting rules for decades
Rodopaios, N. E., Mougios, V., Konstantinidou, A., Iosifidis, S., Koulouri, A.-A., Vasara, E., Papadopoulou, S. Κ., Skepastianos, P., Dermitzakis, E. T., Hassapidou, M. N., et al. (2019) · Archives of Osteoporosis · doi:10.1007/s11657-019-0625-y · Cited by 15
Analytical Review on Nutritional Deficiencies in Vegan Diets: Risks, Prevention, and Optimal Strategies
Malhotra, A., & Lakade, A. J. (2025) · Journal of the American Nutrition Association · doi:10.1080/27697061.2025.2461218 · Cited by 14
Can the Substitution of Milk with Plant-Based Drinks Affect Health-Related Markers? A Systematic Review of Human Intervention Studies in Adults
Biscotti, P., Bo’, C. D., Carvalho, C., Torres, D. P. M., Reboul, E., Pellegrini, B., Vinelli, V., Polito, A., Censi, L., Porrini, M., et al. (2023) · Nutrients · doi:10.3390/nu15112603 · Cited by 14
“For the above-mentioned reasons, it will be pivotal to perform additional studies exploring the impact of the replacement of animal-derived products [56,57], primarily on markers of bone health, which represents a major critical issue to be clarified.”
Background
Plant-Based Diets and Risk of Hip Fracture in Postmenopausal Women
Sotos‐Prieto, M., Rodríguez‐Artalejo, F., Fung, T. T., Meyer, H. E., Hu, F. B., Willett, W. C., & Bhupathiraju, S. N. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.1107 · Cited by 14
Effect of the consumption of hesperidin in orange juice on the transcriptomic profile of subjects with elevated blood pressure and stage 1 hypertension: A randomized controlled trial (CITRUS study)
Pla‐Pagà, L., Valls, R. M., Pedret, A., Calderón-Pérez, L., Llauradó, E., Companys, J., Domenech-Coca, C., Canela-Canela, N., Bas-Prior, J. M. D., Caimari, A., et al. (2021) · Clinical Nutrition · doi:10.1016/j.clnu.2021.10.009 · Cited by 14
Nutrient Profiling of Romanian Traditional Dishes—Prerequisite for Supporting the Flexitarian Eating Style
Voinea, L., Popescu, D. V., Negrea, T. M., & Dina, R. (2020) · Information · doi:10.3390/info11110514 · Cited by 13
Self-reported Resistance Training Is Associated With Better HR-pQCT–derived Bone Microarchitecture in Vegan People
Wakolbinger, R., Reinweber, M., König, J. S., Pokan, R., König, D., Pietschmann, P., & Muschitz, C. (2022) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgac445 · Cited by 14
Nutrition and Physical Activity in Musculoskeletal Health
Dominguez, L. J., Veronese, N., Smith, L., Ragusa, F. S., Bella, G. D., Battaglia, G., Bianco, A., & Barbagallo, M. (2025) · Endocrines · doi:10.3390/endocrines6010010 · Cited by 15
“A meta-analysis of 20 studies and 37,134 participants found that adherence to vegetarian and vegan dietary patterns was associated with lower BMD and increased fracture risk [99], although important methodological concerns have been found in this meta-analysis [100].”
Plant-based diets: a fad or the future of medical nutrition therapy for children with chronic kidney disease?
Nhan, J. K., Sgambat, K., & Moudgil, A. (2023) · Pediatric Nephrology · doi:10.1007/s00467-023-05875-4 · Cited by 13
“Otherwise, there is a clinically significant increased risk of fracture when dietary calcium intake is inadequate [8].”
Vitamin D intake and status in children and adolescents: Comparing vegetarian, vegan, and omnivorous diets
Devulapalli, C. S. (2024) · Acta Paediatrica · doi:10.1111/apa.17463 · Cited by 11
“28 Prepubertal children on vegetarian diets also show lower lumbar spine BMD z-scores, though absolute BMD values remain unchanged.”
Environmental and personal factors for osteoporosis or osteopenia from a large health check-up database: a retrospective cohort study in Taiwan
Chung, P.-C., & Chan, T. (2022) · BMC Public Health · doi:10.1186/s12889-022-13938-8 · Cited by 11
“Vegetarians, especially vegans, have a lower BMD and a higher fracture risk than non-vegetarians [32].”
Background
Urinary Potential Renal Acid Load (uPRAL) among Vegans Versus Omnivores and Its Association with Bone Health in the Cross-Sectional Risks and Benefits of a Vegan Diet Study
Penczynski, K. J., Remer, T., Menzel, J., Abraham, K., & Weikert, C. (2022) · Nutrients · doi:10.3390/nu14214468 · Cited by 11
“Amongst the most prominent health concerns associated with veganism is lower bone health [1], as indicated by lower bone mineral density (BMD) and higher fracture rates among vegans compared to omnivores in two meta-analyses of observational studies [2,3].”
BackgroundResult
The Association of Aromatic Amino Acids with Incident Hip Fracture, aBMD, and Body Composition from the Cardiovascular Health Study
Le, B. K., Bůžková, P., Robbins, J. A., Fink, H. A., Raiford, M., Isales, C. M., Shikany, J. M., Coughlin, S. S., & Carbone, L. D. (2019) · Calcified Tissue International · doi:10.1007/s00223-019-00562-9 · Cited by 11
A Qualitative Study of Rural Plant-Based Eaters’ Knowledge and Practices for Nutritional Adequacy
Leonetti, M., Kolodinsky, J., Trubek, A., & Belarmino, E. H. (2024) · Nutrients · doi:10.3390/nu16203504 · Cited by 10
“While nutritional planning for the eight nutrients evaluated in this study is most critical for those with the most restrictive diets [18,30], other plant-Nutrients based diets that are poorly planned may still fall short of these nutrients.”
Background
Osteoporosis risk and its association with all-cause and cause-specific mortality among the elderly: a 16-year nationwide cohort study
Pan, X.-B., Ma, Q., Gao, T., Zhang, T., Jian, X., Ma, X., & Liu, Y. (2025) · BMC Geriatrics · doi:10.1186/s12877-025-05843-7 · Cited by 10
“This dietary pattern is associated with reduced protein intake, which can lead to decreased calcium-related vitamin D absorption and subsequently result in lower BMD and an increased risk of fractures [63–64].”
Promoting ROS scavenging and osteogenic differentiation by metal–phenolic network nanoparticle-embedded microenvironment-responsive hydrogel for the repair of senile osteoporotic bone defects
Zhang, S., Zhang, S., Fan, W., Liu, C., & Chen, X. (2025) · Journal of Materials Chemistry B · doi:10.1039/d5tb00965k · Cited by 11
Changes in Bone Mineral Density and Trabecular Bone Score over Time between Vegetarian and Non-Vegetarian Middle-Aged and Older Women: A Three-Year Retrospective Medical Record Review
Chuang, T., Koo, M., Chuang, M., Lin, C., Huang, C.-H., & Wang, Y. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19042445 · Cited by 10
“In addition, vegans were more prone to fractures than omnivores [41].”
Background
Veganism and animal welfare, scientific, ethical, and philosophical arguments
Mota‐Rojas, D., Whittaker, A. L., Vega, L. T. D. L., Ghezzi, M. D., Lezama-García, K., Domínguez-Oliva, A., Falcón, I., Casas-Alvarado, A., & Alonso-Spilsbury, M. (2023) · Journal of Animal Behaviour and Biometeorology · doi:10.31893/jabb.23015 · Cited by 12
“As a result, the number of vegans and vegetarians has increased markedly in recent decades (Iguacel et al 2019).”
Background
Increased Consumption of Plant Foods is Associated with Increased Bone Mineral Density
Berg, J., Seyedsadjadi, N., & Grant, R. (2020) · The journal of nutrition health & aging · doi:10.1007/s12603-020-1339-y · Cited by 10
“The long term effect of plant-based diets on bone health is thus difficult to assess and somewhat contentious with a recent meta-analysis linking vegetarian and vegan diets to lower BMD and higher risk of fracture (23).”
Background
Should we all go pesco-vegetarian?
Estruch, R., Sacanella, E., & Ros, E. (2020) · European Heart Journal · doi:10.1093/eurheartj/ehaa1088 · Cited by 10
Risk of Bone Fracture on Vegetarian and Vegan Diets
Kraselnik, A. (2024) · Current Nutrition Reports · doi:10.1007/s13668-024-00533-z · Cited by 9
“…prior to the publication of the studies mentioned above already indicated a lower BMD and an increased risk of fractures in people on a vegan diet [11], although as an important limitation, only “raw” (unad-justed) risks were taken, which skews the results towards poorer bone health in the…”
Animal board invited review: Dietary transition from animal to plant-derived foods: Are there risks to health?
Givens, D. I. (2024) · animal · doi:10.1016/j.animal.2024.101263 · Cited by 11
Effects of partial replacement of red and processed meat with non-soya legumes on bone and mineral metabolism and amino acid intakes in BeanMan randomised clinical trial
Itkonen, S. T., Karhu, P., Pellinen, T., Lehtovirta, M., Kaartinen, N. E., Männistö, S., Päivärinta, E., & Pajari, A. (2023) · British Journal Of Nutrition · doi:10.1017/s0007114523001514 · Cited by 11
“Recent meta-analyses have shown that both vegetarians and vegans have lower bone mineral content at the lumbar spine and femoral neck than omnivores, and vegans also have higher fracture rates (10,11) .”
Background

Authors: Iguacel, I., Miguel-Berges, M. L., Gómez-Bruton, A., Moreno, L. A., & Julián, C.
Affiliations: Universidad de Zaragoza (ES)
University of Zaragoza, Zaragoza, Spain
Corresponding author: Iguacel, Isabel
ORCID: Iguacel, Isabel
Moreno, Luis A
Julián, Cristina
Venue: Nutrition Reviews
Publisher: Oxford University Press (OUP)
Published: 2018-10-29
Volume: 77
Issue: 1
Pages: 1-18
ISSN: 0029-6643 (ISSN-L)
1753-4887
DOI: 10.1093/nutrit/nuy045
OpenAlex: W2905381903
Cited by: 222
References: 90
Citations by year: 2026: 21 · 2025: 32 · 2024: 35 · 2023: 35 · 2022: 30 · 2021: 32 · 2020: 27 · 2019: 10
FWCI: 3.53
Type: journal article
Language: en
Open access: closed
Licence: academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
Locations: Nutrition Reviews (publishedVersion)
PubMed (publishedVersion)
Zaguan (University of Zaragoza Repository) (submittedVersion)
Funders: FPU Predoctoral Programs (FPU014/00922)
Spanish Ministry of Education and Science
Topics: Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Vitamin D Research Studies
Keywords: vegan diet, vegetarian diet, bone mineral density, fracture risk, bone health, femoral neck, lumbar spine, omnivorous diet, calcium intake
MeSH terms: Humans, Risk Factors, Diet, Vegetarian, Bone Density, Fractures, Bone

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Veganism, vegetarianism, bone mineral density, and fracture risk: a systematic review and meta-analysis

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