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Veganism, vegetarianism, bone mineral density, and fracture risk: a systematic review and meta-analysis
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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“In support, a recent systematic review and meta-analysis revealed that vegans had a lower bone mineral density than omnivores [271].”
From Nutritional Considerations for the Vegan Athlete (2023) · cites this paper as [271]
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Vegan, Pesketaryen, Vejeteryan Diyet ve Kanser Riski
Yaşa, Y., & Karadağ, E. (2023) · Bilecik Şeyh Edebali Üniversitesi Sağlık Bilimleri Fakültesi Dergisi · doi:10.61535/bseusbfd.1342903 · Cited by 1
Svart, M. V., Gormsen, L. C., Espersen, R., Rittig, N. F., Starup‐Linde, J., Møller, N., & Rejnmark, L. (2021) · Bone · doi:10.1016/j.bone.2021.116166 · Cited by 1
Alternativna prehrana: pregled literature
Šetinc, L. (2022) · Slovenian Medical Journal · doi:10.6016/zdravvestn.2994
Nutritional factors to support bone health in older adults
Groenendijk, I. (2023) · doi:10.18174/589777 · Cited by 1
Rizzoli, R. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-818460-8.00028-9
PSYCHOLOGICAL CONCERNS OF NOURISHMENT WITH SPECIAL FOCUS ON TRANSGENERATIONAL TRAUMA
Kökény, T., Zala, B. B., Széles, Á., Horváth, M., Tóth, E., & Tóth, L. (2020) · The Journal of School and University Medicine · doi:10.51546/jsum.2020.7404
“Vegetarian lifestyle may contribute to bone loss, low height, and low weight based on existing evidence (Li et al. 2020, Iguacel et al. 2019).”
BackgroundSingh, V. V., Yadav, A., Bansal, A. K., Singh, V. K., Verma, S. K., Saxena, S., Kirar, V., Singh, M., Kumar, B., & Singh, S. N. (2022) · BLDE University Journal of Health Sciences · doi:10.4103/bjhs.bjhs_8_21
“[25] In a study, there was no significant change observed in bone density in 27 vegetarian and 37 nonvegetarian diet‑consuming premenopausal women.”
Religious fasting and eating habits in older people
Иванникова, Е. В., & Dudinskaya, Е. N. (2022) · Russian Journal of Geriatric Medicine · doi:10.37586/2686-8636-2-2022-86-95
Prévention nutritionnelle de l’ostéoporose chez l’adulte
Paccou, J., Lecerf, J., & Biver, E. (2022) · Revue du Rhumatisme Monographies · doi:10.1016/j.monrhu.2022.08.001
Le risque de fracture est-il majoré chez les végans ?
Herrou, J., Lecerf, J., & Paccou, J. (2022) · Revue du Rhumatisme · doi:10.1016/j.rhum.2022.11.008
Dietary transition from animal to plant-derived foods: Are there risks to health?
Givens, D. I. (2023) · Animal - science proceedings · doi:10.1016/j.anscip.2023.01.421
Laurenti, R., Fioretti, M., Martin, L. S. M., Tanzini, F., Marotto, D., Gubinelli, E., & Migliore, A. (2023) · Journal of Pharmacy and Nutrition Sciences · doi:10.29169/1927-5951.2023.13.03
Mukherjee, U., & Venkataraman, P. (2024) · Problemy Ekorozwoju · doi:10.35784/preko.5324
Mendes, A. P., Pereira, F., & Teixeira, V. H. (2023) · Springer eBooks · doi:10.1007/978-3-031-33867-0_5
Rickets and Osteomalacia – Vitamin D-Sensitive and -Resistant States
Cianferotti, L. (2023) · Endocrinology · doi:10.1007/978-3-030-19632-5_5-1
The promising form of supporting the treatment of depression
Halczuk, I., Stachura, B., Górska, J., Gawryszczak, S., Gliwa, A., & Nowak, K. (2024) · Journal of Education Health and Sport · doi:10.12775/jehs.2024.71.49421
Protein Intake and Bone Health in the Elderly
Götz, H., & Amrein, K. (2024) · Osteologie/Osteology · doi:10.1055/a-2331-4663
“Certainly, the ideal option is to seek professional dietician advice, although this will often not be feasible.”
Jin, Y., Li, M., Ding, W., & Wu, H. (2024) · Journal of Medical Biochemistry · doi:10.5937/jomb0-48471
“Insufficient BMD has been demonstrated to lead to the development of fractures and osteoporosis (3, 4).”
BackgroundKnochengesundheit bei veganer Ernährung
Kolm, M. (2024) · Springer eBooks · doi:10.1007/978-3-662-68301-9_6
Asif, T., Ouřadová, A., Martínez-Tabar, A., Bullón‐Vela, V., Müller, S., Dietrich, J., Keller, V. D. R., Heniková, M., Selinger, E., Herter‐Aeberli, I., et al. (2024) · Frontiers in Nutrition · doi:10.3389/fnut.2024.1438740
“Vegans may face an elevated risk of accelerated bone turnover, decreased bone mass, and an increased susceptibility to fractures (18).”
BackgroundVegane Ernährung aus osteologischer und endokrinologischer Sicht
Reif, A., & Amrein, K. (2025) · Journal für Endokrinologie Diabetologie und Stoffwechsel · doi:10.1007/s41969-024-00257-z
Plant-based diets and bone health
Migliaccio, S., Piciocchi, C., Defeudis, G., & Mocini, E. (2024) · International Journal of Bone Fragility · doi:10.57582/ijbf.240402.049
Kandakurti, P. K., Ferreira, A. D. S., Nogueira, L. A. C., Watson Arulsingh, D. R., & Patil, S. S. (2025) · Journal of Back and Musculoskeletal Rehabilitation · doi:10.1177/10538127251326152
“46 Further examination revealed a notable relationship between physical activity levels and kinesiophobia in patients with CLBP. 49 A recent systematic review indicated that traditional cognitive-behavioral therapy (CBT) signi fi cantly enhances depression, anxiety, and overall quality of life for…”
InfluentialLifestyle Medicine Approaches to Bone Health: State of the Field and Future Directions
Akselrad, M. D., Via, M. A., & Mechanick, J. I. (2025) · Springer eBooks · doi:10.1007/978-3-031-82888-1_13
Eshel, G. (2025) · The MIT Press eBooks · doi:10.7551/mitpress/13832.001.0001
Deng, Y.-J., Zhang, Q., Ren, M.-X., Zhang, Y., Li, G., Feng, H., Wang, X.-B., Cui, Y.-H., Huang, J., Mao, X.-L., et al. (2025) · Food & Function · doi:10.1039/d5fo01417d · Cited by 3
Wenderlein, J., Burkhardt, W., Dietrich, S., Trefflich, I., Penczynski, K. J., Thomas, K., Salzinger, C., Abraham, K., Malorny, B., Weikert, C., et al. (2025) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2025.08.008
Metadata
- 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
- 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
- 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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