Do vegans have weaker bones?

The objection

“Vegans have weaker bones and break them more often, and the studies say so. In EPIC-Oxford the gap survived even after allowing for calcium, protein and body weight, so telling people to plan their diet doesn’t answer it.”

The answer

The objection gets the evidence broadly right. Vegans have lower bone density on average and, in the large studies that have followed them for years, more fractures, most clearly of the hip. What those studies can’t yet tell us is how much of the gap a well-planned vegan diet would close, because most of them recorded little about diet quality, which a 2025 review of the evidence called a significant limitation [2].

Is bone density lower in vegans?

Bone density is a few per cent lower in vegans on average, and at the spine the gap is larger than in vegetarians who eat dairy and eggs. A 2019 systematic review of 20 studies and 37,134 people found lower density in both vegetarians and vegans than in omnivores at the lumbar spine and at the femoral neck, at the top of the thigh bone [4]. A Bayesian meta-analysis from 2009 (Ho-Pham et al.) put the gap at about 4% for vegetarians and vegans taken together and 6% at the spine for vegans alone, and judged it clinically insignificant [5]. That verdict came before the large fracture studies below.

A 2025 meta-analysis of 20 observational studies found higher odds of osteoporosis at the lower spine in people on plant-based diets than in omnivores (odds ratio 2.44, 95% CI 1.12 to 5.33), while at the femoral neck the odds were higher too but the difference was not statistically clear (1.91, 0.68 to 5.42) [6]. For vegans alone the odds were 1.45 at the spine (1.00 to 2.12), a borderline result, and 1.79 at the femoral neck (0.94 to 3.54), which was not statistically clear; the studies differed widely, mainly because they were designed in different ways [6].

Two small studies from 2024 found no significant difference. In Australia, Austin et al. compared 48 vegans with 48 regular meat-eaters, in a study where every diet group met recommended calcium and protein intakes, and found no significant difference in whole-body bone density on DXA scans once lifestyle, social factors and BMI were allowed for [15]. Galchenko et al. studied 46 vegans, 38 vegetarians and 44 omnivores and found no difference in bone density at the lumbar spine or femoral neck, although the vegans had higher levels of parathyroid hormone than the omnivores, and the authors acknowledge that many studies, including recent ones, have found the opposite [16]. Both were one-off snapshots of fewer than 50 vegans, one author of the Australian study was also working part-time for a health food company, which the authors say had no input, and neither outweighs the pooled reviews above.

How much higher is the fracture risk for vegans?

In EPIC-Oxford (2020), vegans had a 43% higher risk of fracture than meat-eaters and 2.3 times their risk of hip fracture, and a 2025 analysis pooling four studies put the excess risk of hip fracture at 75%. EPIC-Oxford (Tong et al.) followed about 55,000 UK adults, 1,982 of them vegan, through hospital records for an average of 17.6 years, and its figures allow for body weight, exercise, smoking and other differences between the groups [1]. In absolute terms that is about 15 more hip fractures for every 1,000 people over ten years (26.5 per 1,000 against 11.5), and about 19 more fractures of any kind [1].

EPIC-Oxford is the only one of the four pooled studies to report fractures site by site [2]. The excess was concentrated in the hip, in the leg, where the rate was about twice the meat-eaters’, and in a combined group of collarbone, rib and spine fractures, where only the spine stood out when the three were looked at separately [1]. For wrist and ankle fractures, and for arm fractures once body weight was allowed for, the study found no clear difference [1].

The 2025 meta-analysis (Ballarin et al.) pooled EPIC-Oxford with three other cohorts from the UK and North America, 5,344 vegans in all, and found a 75% higher risk of hip fracture in vegans than in meat-eaters (hazard ratio 1.75, 95% CI 1.17 to 2.63), which the authors put at about 8 extra hip fractures per 1,000 people, somewhere between 2 and 17, without saying over what period; the four studies followed people for 15.2 years on average, so the figure can’t be set directly against EPIC-Oxford’s ten-year one [2]. Vegetarians had a 25% higher risk (1.25, 1.11 to 1.39), or about 2 extra hip fractures per 1,000 [2]. The authors rated the vegan estimate as very low certainty, because the studies were open to bias, disagreed with one another and were imprecise [2].

Do calcium, protein and body weight explain vegans’ higher fracture risk?

Lower body weight and lower calcium and protein intakes explain only part of vegans’ higher fracture risk: in EPIC-Oxford the gap narrowed as each was allowed for, but never closed. The vegans in that study had a lower body mass index (22.1 on average, against 24.5 in meat-eaters) and ate much less calcium (591 mg a day, against 1,005 mg) [1]. Among vegans who met UK targets for both calcium and protein the excess remained, although by then the numbers were small, with 13 hip fractures among those vegans [1].

What EPIC-Oxford allowed for	All fractures	Hip fractures
Lifestyle and social factors	1.50 (1.26 to 1.78)	2.64 (1.90 to 3.67)
Plus body weight (BMI)	1.43 (1.20 to 1.70)	2.31 (1.66 to 3.22)
Plus calcium and protein intake	1.30 (1.08 to 1.56)	1.94 (1.35 to 2.77)
Only people meeting UK calcium and protein targets	1.45 (1.07 to 1.97)	2.43 (1.38 to 4.28)

The table gives hazard ratios for vegans against meat-eaters, with 95% confidence intervals, where 1.00 would mean no difference [1]. An earlier and shorter EPIC-Oxford analysis, published in 2007, found no extra risk in vegans eating at least 525 mg of calcium a day, but the 2020 analysis, which drew on hospital records over 17.6 years where the earlier one relied on fractures people reported over five, did not reproduce it [1].

The authors list the limits themselves. Diet questionnaires measure calcium and protein with substantial error, so the role of calcium may have been underestimated, and the study had no record of calcium supplements or of what caused each fracture [1]. Most participants were white and 77% were women, which may limit how far the results apply to other groups, and the authors call for research on vitamin D and B12 levels and on weaker muscles and falls [1].

Do calcium and vitamin D supplements help vegans’ bones?

Calcium and vitamin D supplements might help vegans’ bones, but the evidence in vegans is thin and observational: in the Adventist Health Study-2 (2021), vegan women who took both showed no clear excess risk of hip fracture compared with non-vegetarian women who took both, a finding from a small subgroup. The study followed 34,542 white North American adults, women around or after the menopause and men aged 45 and over, for a median of 8.4 years [3]. Overall, vegan women had a 55% higher risk of hip fracture than non-vegetarian women (hazard ratio 1.55, 1.06 to 2.26), with crude rates of 3.9 and 2.4 hip fractures per 1,000 women a year, while vegan men showed no clear difference from non-vegetarian men (1.01, 0.61 to 1.68) [3]. Among women who took neither supplement, vegans had almost three times the risk of non-vegetarian women who also took neither (hazard ratio 2.99, 1.54 to 5.82); among women who took both, the figure was 0.84 (0.42 to 1.66) [3]. The subgroups were small and the hip fractures self-reported, and because the study is observational, women who took supplements may have differed from those who didn’t in other ways that affect fracture risk; its authors say more research is needed to confirm the finding [3].

Health bodies disagree about calcium tablets in general. The US Preventive Services Task Force, whose 2018 statement is now being updated, based its advice on randomised trials: it recommends against daily vitamin D of 400 IU or less with calcium of 1,000 mg or less to prevent fractures in postmenopausal women who don’t live in care homes, says there is too little evidence to judge higher doses or supplements for men and for women before the menopause, and found that the combination raises the risk of kidney stones, a harm it judged small [17]. Its advice doesn’t cover people who already have osteoporosis, vitamin D deficiency, a past osteoporotic fracture or a raised risk of falls [17]. Victoria’s Better Health Channel (2025) says 500 to 600 mg a day is safe and effective at reducing the risk of fractures in people who don’t get enough calcium from food [9], while the charity Osteoporosis New Zealand says there is no evidence that supplements prevent fractures and that they could possibly cause heart problems in women after the menopause [10]. The BDA mentions the reported link with heart problems, and says the Department of Health reviewed it and saw no need to change its advice on prescribing calcium supplements [8]. The BDA, the Better Health Channel and Osteoporosis New Zealand all say food should come first [8][9][10].

How can vegans protect their bones?

The steps that protect anyone’s bones need more planning on a vegan diet: enough calcium, vitamin D and protein every day, and weight-bearing and resistance exercise, though in EPIC-Oxford (2020) vegans who met calcium and protein targets still had more fractures than meat-eaters [1]. Adults in the UK are advised to get 700 mg of calcium a day [7]. Fortified plant milks and calcium-set tofu are the easiest ways to get there. The British Dietetic Association lists 120 to 190 mg of calcium in 100 ml of fortified plant drink, so a 200 ml glass matches or beats its figure of 240 mg for the same glass of cow’s milk, and 300 mg in 100 g of tofu set with calcium chloride (E509) or calcium sulphate (E516) [8]. Organic plant milks are often unfortified, so check the label [8].

Greens are a top-up. Broccoli’s calcium is well absorbed, at around 50 to 60%, but a cooked cup carries only about 50 mg, and a cooked cup of spinach holds 80 mg of which only about 5% may be absorbed [9]. The BDA says spinach, beans, seeds and nuts shouldn’t be relied on as main sources, because oxalates and phytates reduce how much of their calcium the body absorbs [8]. The BDA sets higher targets for some groups: 800 mg a day for girls and 1,000 mg for boys aged 11 to 18, 1,250 mg for breastfeeding mothers, and 1,200 mg for women after the menopause and men over 55 [8]. The figures for other countries are below, and what studies of vegan children have found about growth and bone is covered in the answer on vegan diets for children and pregnancy.

Vitamin D helps the body absorb calcium [11]. The NHS advises everyone to consider a daily 10 microgram supplement in autumn and winter, and all year for people who are rarely outdoors, cover most of their skin or have dark skin [12]. It says adults should not take more than 100 micrograms a day, and that some people’s medical conditions mean they may not be able to take that much safely, so ask a doctor if in doubt [12]. Enough protein matters too: the EPIC-Oxford authors noted in 2020 that studies had linked higher intakes to better bone density at the spine, although a meta-analysis they cited found no clear link with fractures [1]. Weight-bearing and resistance exercise are, in the NHS’s words, “particularly important for improving bone density”, and swimming and cycling don’t count as weight-bearing [11].

Very low body weight is a risk to bone on any diet. The NHS lists a BMI of 19 or less, an eating disorder, and periods that stop for more than six months because of dieting or over-exercise among the things that raise the risk of osteoporosis [13]. If eating has become about restriction, a GP is the place to start, and the eating-disorder helplines for each country are below.

Food comes first for calcium, but if you take a supplement, the NHS says 1,500 mg a day or less is unlikely to cause harm [7], and the BDA advises talking to a pharmacist, doctor or registered dietitian first if you take other medication or think you need more than 500 mg extra a day [8]. Anyone taking a bone medicine such as alendronic acid should tell their doctor about any supplement containing calcium [14]. The NHS says alendronic acid is usually best taken 30 minutes before breakfast, on an empty stomach and with plain tap water, and not with milk, juice, tea, coffee or mineral water, because they reduce how much of it is absorbed, so a calcium-fortified plant milk belongs with breakfast, after that half hour [18]. Nobody should change or stop a prescribed medicine without speaking to their GP.