Do you need dairy for calcium and strong bones?

The objection

“Vegans in a major British study had 43% more fractures than meat-eaters, and when Australian care homes added milk, yoghurt and cheese to their residents’ meals, fractures fell by a third. Most people get their calcium from dairy, so you need it for strong bones.”

The answer

The fracture finding is real, and it is the strongest reason for vegans to take calcium seriously, but the study behind it didn’t analyse dairy or any other single food, so it can’t show that calcium has to come from a cow [1]. Adults in the UK are advised to get 700 mg of calcium a day [2]. Fortified plant milks and calcium-set tofu are the easiest ways to get there, and organic plant milks are often unfortified, so check the label [3]. Kale, a low-oxalate green, gives up its calcium easily [7], but a portion of broccoli or spring greens carries only 40 to 55 mg, so treat greens as a top-up [3].

The 43% comes from EPIC-Oxford (Tong et al., 2020), which followed 54,898 UK adults, 1,982 of them vegan at the start, for an average of 17.6 years, picking up fractures from hospital records [1]. After allowing for smoking, physical activity, education and other differences, vegans had a 50% higher rate of fractures than meat-eaters. Allowing for their lower BMI as well brought that to 43%, with 2.31 times the meat-eaters’ rate of hip fractures, which works out at 19.4 more fractures of any kind and 14.9 more hip fractures for every 1,000 people over ten years [1]. The vegans ate far less calcium, 591 mg a day on average at the start against 1,005 mg for the meat-eaters, and less protein too [1].

Allowing for calcium and protein intake shrank the gap without closing it. Vegans still had about 30% more fractures overall and roughly twice the rate of hip fractures, and among people who met the UK’s targets for both calcium and protein the vegans’ rate was still 45% higher, though that figure rests on only 44 fractures among them [1]. Vegetarians in the same study, whose diets included dairy or eggs and who averaged 1,030 mg of calcium a day, also had a 25% higher rate of hip fractures than meat-eaters after allowing for BMI, or 2.9 more for every 1,000 people over ten years [1]. The authors conclude that calcium and protein may at most partly explain the differences, though they couldn’t allow for calcium supplements and note that questionnaires measure intake with substantial error, so calcium’s part may be understated. They also point to body weight, since a lower BMI may mean less cushioning in a fall, and call for research on muscle strength, after an earlier UK study found lower grip strength in vegetarians and vegans [1].

An earlier and shorter EPIC-Oxford analysis (Appleby et al., 2007), based on self-reported fractures over about five years, found no extra risk among vegans eating at least 525 mg of calcium a day [4]. The 2020 analysis, with nearly 4,000 fractures taken from hospital records, did not reproduce that finding [1]. EPIC-Oxford is observational, its participants were mostly white and 77% of them women, and it couldn’t tell fractures of fragile bones from those caused by accidents, so on its own it can’t prove cause [1]. Other cohorts point the same way. A 2026 meta-analysis (Ballarin et al.) that pooled EPIC-Oxford with three other cohorts, 529,672 people in all, found a 75% higher rate of hip fractures in vegans and a 25% higher rate in vegetarians than in meat-eaters, though it rated the certainty of that evidence very low for vegans and low for vegetarians [13]. In the Adventist Health Study-2 (Thorpe et al., 2021), which followed 34,542 white women and men aged 45 and over in the US and Canada for a median of 8.4 years, vegan women had a 55% higher rate of hip fractures than non-vegetarians, but vegan women who took both calcium and vitamin D supplements were at no higher risk, a result the authors say still needs confirming, and diet made no difference among men [14]. The wider evidence on vegan bone density and fractures has its own answer.

Does dairy protect against fractures?

Long-term studies find no consistent link between how much milk or total dairy people consume and their risk of fractures, though yoghurt and cheese are more often tied to fewer fractures, and a large 2021 trial found that adding dairy foods to care-home menus low in calcium and protein cut fractures. In a 2015 BMJ systematic review (Bolland et al.), most cohort studies of people over 50 found no association between fractures and milk (25 of 28) or dairy (11 of 13), and at the time there was no trial evidence that more calcium from food prevents fractures [5]. Reviews since then still find mixed results for milk and total dairy, while cheese and yoghurt have been linked more consistently with fewer fractures (Sharifan et al., 2025) [15]. Those links come from observational studies. A 2023 analysis of 13 cohorts with 486,950 adults (Mishra et al.) found no link between total dairy and hip fractures and a 7% higher risk for every 200 g of milk a day up to 400 g, and it noted that the cheese and yoghurt studies didn’t allow for socioeconomic status [16]. None of this makes a very low calcium intake safe: an earlier EPIC-Oxford analysis of self-reported fractures (Key et al., 2007) found that women eating under 525 mg of calcium a day had a 75% higher fracture risk than women eating at least 1,200 mg, with no such link in men [17].

The trial (Iuliano et al., 2021) took place in 60 Australian care homes whose residents, aged 86 on average and routinely given vitamin D, were eating about 600 mg of calcium a day and less than 1 g of protein per kilo of body weight [12]. Homes picked at random to add milk, yoghurt and cheese raised intakes to about 1,142 mg of calcium and 1.1 g of protein per kilo a day, and 3.7% of their residents had a fracture during the trial against 5.2% in homes that kept their usual menus, a 33% lower risk [12]. Hip fractures, in an analysis the researchers had not planned in advance, came to 1.3% against 2.4% [12]. Dairy industry bodies were among the funders, which the authors say played no part in the study [12]. Because extra dairy was compared with usual menus, the trial can’t say whether fortified plant foods supplying the same calcium and protein would do as well.

How can vegans get 700 mg of calcium a day?

Fortified plant milks and yoghurts, calcium-set tofu and, in the UK, white and brown bread are the most reliable sources, since calcium is added to white and brown flour by law there [6]. The British Dietetic Association (BDA) gives these amounts per portion [3]:

Food	Portion	Calcium
Cow’s milk, for comparison	200 ml	240 mg
Calcium-fortified plant drink	100 ml	120 to 190 mg
Calcium-set tofu, uncooked	100 g	300 mg
Calcium-fortified soya, coconut or oat yoghurt	100 g	120 to 210 mg
White bread	2 large slices (100 g)	155 mg
Wholemeal bread	2 large slices (100 g)	105 mg
Kale, boiled	100 g	150 mg
Spring greens	1 serving (75 g)	55 mg
Broccoli, boiled	2 spears (85 g)	40 mg

The plant drink figure is for 100 ml, half the milk portion, so a 200 ml glass of a fortified drink holds 240 to 380 mg, at least as much as the same glass of cow’s milk [3]. The tofu figure holds only for tofu set with calcium sulphate (E516) or calcium chloride (E509), not nigari, and a plant milk without added calcium has no noticeable amount [3]. The NHS also lists sesame seeds, tahini, pulses and dried fruit [6], but the BDA warns that their oxalates and phytates reduce how much calcium the body absorbs, so they shouldn’t be your main sources [3]. The NHS says children can have unsweetened, calcium-fortified plant drinks such as soya, oat or almond from the age of 1 as part of a healthy balanced diet, but children under 5 shouldn’t be given rice drinks, because of the arsenic in them [18]; the BDA puts that age at four and a half [3].

Is calcium from plants absorbed as well as calcium from milk?

It depends on the food: in small absorption studies kale and soya milk fortified with calcium carbonate did at least as well as cow’s milk, while very little of the calcium in spinach got through. In a 1990 isotope study of 11 women, 40.9% of the calcium in kale was absorbed against 32.1% from milk [7]. In a 1988 trial in 13 adults, only 5.1% of the calcium in spinach was absorbed against 27.6% from milk, because oxalate in spinach binds it [8]. With fortified soya milk the calcium salt matters: soya milk fortified with calcium carbonate matched cow’s milk in a 2005 study of 20 young women, while tricalcium phosphate did slightly worse there and reached 75% of cow’s milk’s efficiency in a 2000 study of 16 men [9][10]. These are small, short studies, so treat the exact percentages as a guide.

How much calcium do you need, and can you have too much?

The NHS advises 700 mg of calcium a day for adults. For people taking calcium supplements it says 1,500 mg a day or less is unlikely to cause harm, while high doses of more than 1,500 mg a day could cause stomach pain and diarrhoea [2]. The BDA’s fact sheet (2026) sets a higher figure for older adults, 1,200 mg for women after the menopause and men over 55, and suggests 1,250 mg while breastfeeding [3]. For children the BDA gives 525 mg a day under the age of 1, 350 mg at 1 to 3, 450 mg at 4 to 6 and 550 mg at 7 to 10, and for teenagers aged 11 to 18 it gives 800 mg for girls and 1,000 mg for boys [3].

Both bodies say most people can get enough from food, and the BDA treats supplements as a top-up when food falls short [2][3]. In AHS-2, vegan women who took both calcium and vitamin D supplements had no more hip fractures than non-vegetarians [14]. Whether calcium supplements raise the risk of heart disease is still argued over: a 2021 meta-analysis of 13 placebo-controlled trials (Myung et al.) found about 15% more cardiovascular disease among healthy postmenopausal women taking them [19], while a 2023 meta-analysis of 12 trials (Sim et al.) found no link with heart attack, stroke, hospital admission for heart failure or cardiovascular death [20]. The BDA’s 2026 fact sheet says the Department of Health reviewed earlier reports of a link and didn’t change its advice [3]. If you take any medicine or other supplements, or think you need more than 500 mg a day on top of your food, check with a pharmacist, doctor or registered dietitian first [3], and don’t change or stop a prescribed medicine, including treatment for osteoporosis, without speaking to your GP.

What else do bones need besides calcium?

Vitamin D and the right kind of exercise matter too, and neither depends on dairy. Vitamin D helps the body absorb calcium, and the NHS advises adults to consider a daily 10 microgram supplement because it can be hard to get enough from food alone, and in autumn and winter the UK sun is too weak to make it [11]. Vegans need one whose vitamin D isn’t of animal origin, so read the label [6]. The NHS calls weight-bearing and resistance exercise particularly important for bone density: running, dancing, brisk walking and lifting weights all count, while swimming and cycling aren’t weight-bearing [11]. Protein may play a part as well, since the EPIC-Oxford vegans ate less of it and allowing for protein narrowed their excess risk slightly [1].