Are vegan bones weaker, lower density, more fractures?

The objection

“Vegans have measurably weaker bones and break more often. The studies say so. You can’t argue with a DEXA scan.”

The answer

The studies do say so, in part, and dodging that would be dishonest. A systematic review of 37,000 people found vegetarians and vegans had lower bone mineral density at the hip and spine, the effect larger in vegans, and EPIC-Oxford found vegans had more fractures, notably hip fractures. These are real signals from good data.

The gap exists; the question is why, and the same studies answer it. The shortfall tracks with lower intakes of calcium, protein, vitamin D and B12, plus lower body weight. EPIC-Oxford is the clincher: when calcium intake reached at least 525 mg a day, the vegan fracture rate matched meat-eaters. The bone responds to nutrients and loading. Whether the calcium passed through a cow makes no difference to it.

It’s also worth keeping the magnitude honest in both directions. One Bayesian meta-analysis judged the density difference small enough to be clinically marginal. But “marginal on average” is no comfort to someone who fractures, so the practical answer is the same: don’t run the diet on shortfalls.

What that means in practice: hit calcium through calcium-set tofu, fortified plant milks, tahini and low-oxalate greens, eat enough protein, sort out vitamin D and B12, and do weight-bearing exercise, which builds bone regardless of diet.

A poorly planned vegan diet can weaken bone, and the data caught exactly that. A planned one, with adequate calcium, protein, D and B12, closes the fracture gap. What does the work is the planning.