Vegetarians at greater risk for hip fracture vs. meat eaters, study finds
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Key takeaways:
- Researchers partially attributed the greater fracture risk in vegetarians to lower BMIs.
- Pescatarians and occasional meat eaters did not have an increased risk for hip fracture.
Vegetarians had a greater risk for hip fracture compared with regular meat eaters, although the absolute differences were small and “should be weighed against the potential health benefits of vegetarian diets,” according to researchers.
“Vegetarianism is becoming increasingly popular, but there is a concern around musculoskeletal health,” James Webster, PhD, a postgraduate researcher from the Nutritional Epidemiology Group at the University of Leeds, told Healio. “There are a few previous studies suggesting a higher risk of fractures in vegetarians than in meat eaters, but it is unclear if vegetarian men have a higher risk of hip fracture. Reasons underpinning risk differences are also unclear.”
To better understand associations between dietary patterns and hip fracture risk, Webster and colleagues conducted a prospective cohort study using U.K. Biobank lifestyle and dietary data from 413,914 adults. Among those, 258,765 identified as meat eaters, 137,954 were occasional meat eaters, 9,557 were pescatarians and 7,638 were vegetarians.
Although vegetarians, pescatarians and occasional meat eaters all tended to be younger on average than meat eaters, “time to hip fracture and age at hip fracture were similar across diet groups,” the researchers wrote in BMC Medicine.
Over a median follow-up of 12.5 years, 3,503 hip fractures occurred.
After adjusting for confounders, the researchers found that vegetarians had a greater risk for hip fractures compared with meat eaters (HR = 1.5; 95% CI, 1.18-1.91), with an adjusted absolute risk difference of 3.2 additional fractures per 1,000 people over 10 years. This increased risk was not observed in occasional meat eaters or pescatarians.
Although there was limited evidence of an effect modification by sex, age and BMI, a mediation analysis suggested that BMI was attributed to 28% (95% CI, 1.1-69.8) of the risk difference between vegetarians and meat eaters, according to the researchers.
Webster noted that the benefits of a vegetarian diet include a lower risk for cancer and CVD and “may therefore outweigh any increases in hip fracture risk.”
However, he pointed out that vegetarians “were less likely to meet protein recommendations, had a lower BMI, lower vitamin D and [insulin-like growth factor 1] levels, and had lower dietary intake of several nutrients related to musculoskeletal health.”
“Therefore, vegetarians should maintain a healthy bodyweight and ensure adequate nutrient intakes, particularly for protein,” Webster said. “Additionally, since there was no difference in risk between occasional and regular meat eaters, reducing meat intake from the diet doesn’t seem to meaningfully affect hip fracture risk.”
The study had several limitations, according to the researchers. For example, they were not able to assess diet quality, which may have influenced hip fracture risk. The study also did examine fracture risk among vegans, who are less likely to meet recommended guidelines for protein and calcium and could be at higher risk for hip fracture, they noted.
Because the study was observational, Webster said the “findings cannot show causality.”
“Further studies are needed to confirm if vegetarian diets cause an increase in hip fracture risk and to identify why that might be,” he said. “This information will help to inform risk mitigation strategies.”
Perspective
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This study suggests that individuals following a long-term vegetarian diet have a small increase in risk for hip fractures compared with those who use dietary patterns that include meat. They suggest that this may be partially due to a less overweight BMI on average for individuals following a vegetarian diet, but I would not put much stock in this. It is more likely that individuals following a vegetarian diet tend to have less high-quality protein intake and therefore less muscle mass than individuals who include meat in their diet.
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