Risk of Hip Fractures Greater in Vegetarians Interview with:
James Webster PhD
Lead author
Nutritional Epidemiology Group, University of Leeds What is the background for this study?

Response: Hip fractures are the most severe consequence of osteoporosis and are a major public health problem.

There are growing concerns of poor bone health and higher risk of fractures in vegetarians, but prospective studies comparing risk of hip fracture in vegetarians and meat-eaters over time are scarce and limited.

A study of British men and women in the EPIC-Oxford cohort showed a greater risk of hip fracture in pescatarians, vegetarians, and vegans compared to meat-eaters. The only other study on the topic, the Adventist Health Study of US adults, found no clear evidence of a difference in hip fracture risk between vegetarians and meat-eaters, but identified hip fractures through questionnaires, which are susceptible to selective loss to follow-up.

To build on previous research, we investigated the risk of hip fracture in occasional meat-eaters, pescatarians, and vegetarians compared to regular meat-eaters in middle-aged UK women, who are at a greater risk of hip fracture than men, with hip fractures accurately confirmed using objective and complete hospital records. What are the main findings?

Response:  We conducted a large-scale analysis of diet and hip fracture risk using data from the UK Women’s Cohort Study. The cohort consists of 35,000 UK-based women who completed a questionnaire about their diet and lifestyle between 1995-1998. We linked this data with participants’ hospital records over roughly 20 years to identify who had a hip fracture.

We then grouped the women as regular meat-eaters (ate meat more than five times a week, n=14,000), occasional meat-eaters (ate meat less than five times a week, n=8000), pescatarians (ate fish but not meat, n=3900), or vegetarians (ate neither meat or fish, n=4400). Vegans were included in the vegetarian group as there weren’t enough vegans to study them separately.

Compared with regular meat-eaters, risk of hip fracture was higher in vegetarians (33%), but not in pescatarians or occasional meat-eaters.

Our analyses accounted for factors that could influence hip fracture risk and may vary by diet group, including age, alcohol consumption, smoking, exercise habits, menopausal status, and socio-economic status, amongst other factors. What should readers take away from your report?

Response: In this study of UK women, including around 3900 pescatarians and 4400 vegetarians, vegetarian but not pescatarian women were at a greater risk of hip fracture than those who regularly ate meat. What recommendations do you have for future research as a results of this study?

Response: Further research is needed to confirm our findings in other populations, such as in men and non-European populations.

Given that the vegetarian diet has other health and environmental benefits, it is also important to understand what is driving the higher risk of hip fractures observed in vegetarians in this study so that prevention strategies can be formed.

In particular, further research exploring the roles of BMI and nutrients abundant in animal-sourced foods is recommended, such as protein, vitamin B12, and other micronutrients related to bone health.

This would help facilitate the making of public health interventions and policy guidelines aiming to reduce hip fracture risk in vegetarians through dietary change or weight management. Is there anything else you would like to add? Any disclosures?

Response: We would like to thank the women who participated in the UK Women’s Cohort Study for their invaluable contribution.


Webster, J  Greenwood, DC and Cade, JE (Accepted: 2022) Risk of hip fracture in meat-eaters, pescatarians, and vegetarians: results from the UK Women’s Cohort Study. BMC Medicine. ISSN 1741-7015 (In Press)

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Last Updated on August 21, 2022 by Marie Benz MD FAAD