Research from the University of Leeds, UK, published in the journal BMC Medicine, investigated the risk of hip fracture in occasional meat consumers; pescatarians, people who eat fish but not meat; and vegetarians compared to regular meat eaters.
Among 26,318 women, 822 cases of hip fracture were observed over about 20 years, representing just over 3% of the sample. After adjusting for factors such as smoking and age, vegetarians are the only dietary group with an increased risk of hip fracture; have a 33% higher risk of hip fracture than regular meat eaters.
This study is one of the few comparing the risk of hip fracture between vegetarians and meat eaters and in which the occurrence of hip fracture was confirmed by hospital records.
The scientists stress the need for further research into the exact reasons why vegetarians are at increased risk of hip fracture.
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The lead author of the study, James WebsterPhD researcher at the School of Food Science and Nutrition at Leeds, notes that the study “highlights the potential concern about the risk of hip fracture in women following a vegetarian diet. However, This is not about warning people off the vegetarian diet. As with any diet, it’s important to understand your personal circumstances and the nutrients needed for a healthy, balanced lifestyle.”
“Vegetarian diets can vary greatly from person to person and may or may not be healthy, just like diets that include animal products,” he adds. “Worryingly, however, vegetarian diets often have lower nutrient intakes substances that are related to bone and muscle health These types of nutrients are usually more abundant in meat and other animal products than in plants, such as protein, calcium and other trace elements.
Bone density and muscle mass
“Low intake of these nutrients can lead to lower bone mineral density and muscle mass, which can make the risk of hip fracture more susceptible,” he continued. “This makes it especially important that we continue research to better understand the factors that lead to increased risk in vegetarians, either due to deficiencies in certain nutrients or due to weight control, so that we can help people make a healthy choice.”
Vegetarian diets have grown in popularity in recent years, with a 2021 YouGov survey putting the size of the UK’s vegetarian population at around 5-7%. It is often perceived as a healthier food optionwith previous evidence showing that a vegetarian diet can reduce the risks of several chronic diseases, including diabetes, heart disease and cancer compared to omnivorous diets.
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There is also a global call to reduce the consumption of animal products in an effort to tackle climate change. Therefore, understanding the risk of hip fracture in vegetarians is of increasing public health importance.
The co-author of the study, Prof Janet Cadehead of the nutritional epidemiology group at the School of Food Science and Nutrition in Leeds, explains that ‘hip fracture is a global health problem with high economic costs, which causes loss of independence, reduces quality of life and increases the risk of other health problems.
“Plant-based diets have been linked to poor bone health, but evidence for associations with hip fracture risk is lacking. This study is an important step in understanding the potential risk that plant-based diets may pose in the long term and what can be done to mitigate these risks.
BMI and fracture risk
The team used data from the UK Women’s Cohort Study to explore potential links between diet and hip fracture risk. This national cohort of middle-aged women was established at the University of Leeds to investigate the links between diet and chronic disease, covering a wide range of different dietary patterns. Dietary information was collected using a food frequency questionnaire and validated using a 4-day food diary in a subsample of women. At the time of recruitment for the cohort study, the women were aged between 35 and 69 years.
The research team found that the average BMI of vegetarians is slightly lower than that of regular meat eaters. Previous research has shown a link between a low BMI and a high risk of hip fracture.
A low BMI can indicate that people are underweight, which can mean poorer bone and muscle health and an increased risk of hip fracture. Further research is needed to determine whether low BMI is the cause of the higher risk seen in vegetarians.
The co-author of the study, Dr. Darren Greenwoodbiostatistician at Leeds Medical School, stresses that the study “is only part of the bigger picture of diet and healthy bones and muscles in old age”.
“Further research is needed to confirm whether there may be similar results in men, to explore the role of body weight and to identify the reasons for the different results in vegetarians and meat eaters,” they conclude.