The connection between vegetarian diets and osteoporosis is often discussed, with some uncertainty. Vegetarian diets are usually praised for helping reduce issues like diabetes, high blood pressure, obesity, and certain types of cancer. However, because these diets remove some foods, people sometimes worry about how they affect bone health. In particular, there are questions about whether vegetarian or vegan diets might raise the risk of bone loss and fractures. The true answer depends on careful meal choices and getting certain key nutrients.
Osteoporosis is a disease in which bones lose mass and strength, making them more likely to break. Our bones are always being rebuilt and need a steady flow of nutrients to stay strong. The foods we eat are important throughout our lives, as they help us build bone during childhood and keep it in later years. For people who don’t eat certain animal products-especially vegans-getting enough of the nutrients that support bone health is extra important, so they do not increase their risk of osteoporosis by accident.
What is the link between vegetarianism and osteoporosis?
Can being vegetarian or vegan affect bone health?
Yes, switching to a vegetarian or vegan diet can affect bone health, mostly because you might get less of some nutrients that are important for strong bones. Although vegetarian diets have many good points, avoiding certain animal foods can make it harder to get enough calcium, vitamin D, vitamin B12, protein, and omega-3 fats. Vegans, who avoid all animal foods, usually get much less calcium than vegetarians who eat eggs and dairy or people who eat meat.
But just cutting out animal products isn’t the whole story. Whether or not bone health suffers really depends on how the diet is put together. Good planning can let vegetarians or vegans get plenty of other nutrients that help bones, such as potassium, magnesium, vitamin K, and many plant-based antioxidants. The biggest challenge is making sure that any nutrients you might be missing are replaced by foods, fortified products, or supplements.
What does science say about vegetarianism and osteoporosis risk?
Research looking at vegetarian diets and osteoporosis risk isn’t simple. Some studies show vegetarians and especially vegans can have a higher risk of lower bone mineral density (BMD) and more fractures. For example, a 2009 review covering over 2,700 people found that BMD at the hip and lower spine was around 4% lower in vegetarians and vegans than in people who eat meat. Another summary from 2019 found similar results.
The EPIC-Oxford study-one of the largest in this area-saw a higher risk of hip fracture in fish eaters (HR 1.26), vegetarians (HR 1.25), and vegans (HR 2.31) than in meat-eaters, even when taking things like body weight and lifestyle into account. Vegans also had more total bone fractures. Experts believe the difference is partly because vegans have a lower average body weight, as well as lower intake of protein and calcium. On the other hand, other research has shown that with enough calcium, vegetarians and vegans may not always have a higher risk. Most experts agree that what matters most for bone health is getting the right nutrients, not just whether you eat meat.
How do vegetarian diets affect bone mineral density (BMD) and fracture risk?
What does the research show about BMD in vegetarians and vegans?
Studies on bone mineral density (BMD) in vegetarians and vegans have had mixed results. Some reports say plant-based eaters, especially strict vegans, have lower BMD. For example, one review found BMD in both the hip and spine was 4% lower in vegetarians and vegans. When looking only at vegans, the decrease at the hip was closer to 6%. This is often linked to lower intake of calcium, vitamin D, and protein-nutrients that are easier to get from animal products.
Other research has found that with good planning, vegetarians and omnivores can have similar BMD. Differences in study results often come from differences in the people studied, sample sizes, the kind of vegetarian diet, and factors like physical activity. Also, vegetarians tend to have a lower body weight, which can make comparing BMD harder. This shows that results can change depending on how well the diet is planned and what else about the person may affect bones.
Are meat-free diets linked to more bone fractures?
Do vegetarians and vegans break bones more often? Some large studies say yes, especially for vegans. The EPIC-Oxford study, for example, found that vegans had a much higher risk of hip pockets, total, and leg fractures than people who eat meat. These patterns were linked to having a lighter body weight and possibly not enough protein or calcium in the diet.
But not all evidence agrees. Some shows that if calcium intake is high enough, the fracture risk goes down. So, being meat-free does not, by itself, mean you will break bones more easily-the overall quality of the diet is what really counts. Other things, like lower body weight among vegetarians, might also play a role.
What nutrients in vegetarian diets are important for bone health?
Calcium: Plant sources and absorption
Calcium is a key mineral for bones. On plant-based diets, getting enough calcium can be tricky because vegans don’t eat dairy, the most common source. Still, plenty of plant foods have calcium. Good choices include greens like kale, broccoli, and bok choy, calcium-set tofu, and foods like almond milk or orange juice that have calcium added.
Some plant foods like spinach and rhubarb contain chemicals called oxalates that keep your body from absorbing much calcium. For example, your body can only use about 5% of the calcium in spinach. In contrast, kale and bok choy don’t have much oxalate, so about half the calcium they contain can actually be absorbed. To improve calcium absorption from grains and beans, people can soak, sprout, or ferment them. Eating a variety of calcium-rich plant foods with better absorption rates is important if you don’t eat dairy.
Protein: How vegetarians can get enough
Protein helps build and repair bone. Animal foods are high in protein, but vegetarians and vegans can easily get enough from plant foods. Lentils, beans, nuts, seeds, quinoa, and soy products like tofu and tempeh are all good sources. Soy products especially provide protein similar to that in meat and milk.
While studies show vegetarians and vegans might eat a little less protein than meat-eaters, there is no problem as long as their diet is varied and includes protein-rich plant foods. Some research suggests even plant protein can help bones by helping the body use calcium better. Older adults or anyone with higher protein needs may need to eat more dense protein foods like soybeans or seitan.
Vitamin D: Getting enough as a vegetarian
Vitamin D is important because it helps your intestines take up calcium and keeps bones mineralized. For vegetarians and especially vegans, getting enough can be difficult. Most food sources are animal-based or fortified dairy. Some mushrooms make vitamin D if exposed to sunlight, but these are usually not enough to meet daily needs (600-800 IU/day for adults).
Fortified foods are especially helpful. These include fortified plant milks, some cereals, orange juice, and some kinds of margarine. Geography matters-some places have more of these foods available than others. Many studies report that plant-based eaters have lower blood levels of vitamin D. Because of this, many vegetarians and vegans need supplements to reach the recommended level, even if they get some from sunlight.
Vitamin B12: Why it matters for bones
Vitamin B12 isn’t just important for nerves and making blood-it also affects bones. Not getting enough B12 can lower bone mineral density and raise fracture risk. B12 helps keep homocysteine in check; without enough B12, homocysteine rises, and this can increase bone breakdown.
Since B12 is only found naturally in animal foods, vegetarians (and especially vegans) need to use fortified products or supplements. Dairy and eggs help lacto-ovo vegetarians get some B12, but vegans must rely on breakfast cereals, fortified milks, or B12 pills. Some studies show lots of vegans and vegetarians are low in B12 if they don’t supplement, which could hurt bone health.
Iron, zinc, and other micronutrients
Other nutrients, like iron and zinc, also support healthy bones. Iron is important for collagen in bone, and affects vitamin D. Plant foods (beans, seeds, greens) have iron, but the type in plants (non-heme iron) isn’t absorbed as well as animal iron. Vegetarians are at higher risk for iron deficiency, which could increase bone breakdown.
Zinc is needed for bone growth and repair. Although found in whole grains and beans, zinc is less well absorbed from plant foods because of something called phytates. Soaking, sprouting, and fermenting grains and beans can help. Magnesium, potassium, and vitamin K-found in nuts, seeds, fruits, and leafy greens-also support bone health. Eating a wide range of these foods is necessary for vegetarians to keep bones healthy.
What vegetarian foods are best for bone health?
Best plant calcium sources
To keep bones healthy on a vegetarian diet, focus on these calcium-rich options:
- Calcium-set tofu
- Fortified plant milks (soy, almond, oat)
- Low-oxalate leafy greens like kale, bok choy, collard greens
- Fortified cereals and orange juice
- Legumes (black beans, chickpeas)
- Sesame seeds and tahini
Using a mix of these foods throughout your meals will help you meet your daily calcium needs.
Good vegetarian protein sources for bones
These foods provide enough protein for vegetarians:
- Beans and lentils (black beans, chickpeas, kidney beans)
- Soy foods (tofu, tempeh, edamame)
- Nuts and seeds (almonds, chia seeds, pumpkin seeds)
- Whole grains (quinoa, amaranth, buckwheat)
- Dairy and eggs (for lacto-ovo vegetarians)
Eating a variety of these each day covers all the different amino acids your body needs for healthy bones and muscles.
Vegetarian-friendly foods high in vitamin D and B12
Getting vitamin D and B12 can be hard if you don’t eat animal foods, but these plant-based sources help:
- Mushrooms exposed to UV light (vitamin D2)
- Fortified plant milks and cereals (vitamin D and B12)
- Eggs and dairy (B12 for vegetarians who eat them)
- Nutritional yeast and some vegan meat substitutes (fortified with B12)
Read labels closely, as not all brands add enough of these vitamins. For many vegetarians and vegans, supplements are still a good idea to prevent deficiencies that could weaken bones.
Common issues vegetarians face with osteoporosis
Does a plant-based diet lower calcium absorption?
One problem with plant-based diets is that certain chemicals in plant foods can block calcium from being absorbed as easily. Oxalic acid, found in spinach, rhubarb, and Swiss chard, binds calcium and keeps the body from using it-sometimes allowing only 5% of the calcium to be absorbed. Phytic acid, found in grains, beans, and nuts, also slows down calcium absorption, but less than oxalates do. Soaking and sprouting these foods helps reduce the amount of phytate they contain.
The key is to rely on foods like calcium-set tofu, fortified plant milks, and low-oxalate greens, which provide calcium your body can actually use.
Bone health for menopausal vegetarians
Menopause speeds up bone loss because less estrogen is made, which protects bones. Women going through menopause who eat vegetarian or vegan need to make a special effort to eat enough bone-supporting nutrients. They should aim for two or three servings of calcium-rich foods daily from sources such as fortified plant milks, tofu with added calcium, and low-oxalate greens.
Good protein is important, so include beans, soy, nuts, and seeds in meals. Vitamin D is also key for calcium absorption-here, supplements are often needed. Since muscle loss also happens during menopause, regular strength and balance exercises can help keep bones and muscles healthy and prevent falls.
Coeliac disease and bone health for vegetarians
Coeliac disease, where eating gluten damages your gut, makes it harder to take in nutrients including those that keep bones strong. This is extra serious for vegetarians, who already need to work harder to get enough calcium and vitamin D. If you’re vegetarian and have coeliac disease, you should pick gluten-free, calcium-rich foods such as fortified gluten-free milks and tofu, and a range of low-oxalate greens. Regularly check vitamin D levels and talk with your doctor about supplements. Beans, quinoa, and nuts are good gluten-free protein options.
How can vegetarians lower osteoporosis risk?
Tips for getting enough bone-friendly nutrients on a vegetarian diet
Keeping bones strong with a plant-based diet means planning what you eat. Make sure you get enough calcium by eating calcium-set tofu, fortified plant milks and cereals, and leafy greens like kale and bok choy. These different foods help you absorb more calcium overall. Spinach has a lot of calcium but is not a good main source because the body can’t take in very much of it.
Include protein-rich foods like beans, soy products, nuts, and seeds. For vitamin D and B12, use fortified options and consider supplements. Other nutrients like magnesium, vitamin K, and potassium, common in fruits and leafy greens, also help your bones. A diet with plenty of fruits and vegetables is good for keeping bones healthy.
When should vegetarians consider supplements?
Most nutrients can come from food if you plan carefully, but some-like vitamin B12 and vitamin D-almost always need supplements for vegetarians and vegans. B12 is missing from almost all plant foods, so it’s very important to take a supplement or eat foods with added B12. Not enough B12 can lead to weaker bones and higher fracture risk.
Vitamin D is also hard to get from plants alone, and sunlight isn’t always reliable, especially in winter or cloudy places. Most vegetarians and vegans will benefit from a vitamin D supplement (600-800 IU a day). Calcium can mostly come from food, but if your intake is low, ask your doctor about supplements, especially if you have trouble absorbing nutrients because of conditions like coeliac disease. Zinc and omega-3 supplements may also help if you can’t get enough from food.
Best habits for strong bones
Food isn’t the only thing that matters for bones. Vegetarians should also exercise regularly. Weight-bearing and strength exercises-like walking, running, dancing, and weight-lifting-help bones get stronger and less likely to break. This kind of activity also helps keep muscles fit, which is important to prevent falls. Strength training is especially useful for vegans.
Keeping a healthy weight is important, since being too thin can lower bone density. Don’t smoke or drink too much alcohol-both make bone loss worse. Reducing stress, getting enough sleep, and spending time outdoors for sunlight (for natural vitamin D, while using sun protection) are also good for your bones.
Frequently asked questions about vegetarianism and osteoporosis
Do vegans have a higher risk of bone fractures than people who eat animal foods?
Research has found that vegans can have a higher risk of bone breaks compared to those who eat animal products if their diet isn’t well planned. This is usually because vegans might not get as much calcium, protein, or vitamin D. Vegans often also have a lower body weight, which can affect bone strength.
But this higher risk comes from not getting enough bone-supporting nutrients, not just from being vegan. If vegans get enough calcium (above 525 mg/day), their risk may be similar to others. Using fortified foods and supplements for vitamin D and B12 helps keep bones healthy. So, being vegan is not a problem for bones as long as the diet is planned smartly.
Which plant foods make it harder for the body to use calcium?
Certain plant foods have chemicals that block calcium absorption. The main ones are:
- Oxalic acid (oxalates): Found in high amounts in spinach, rhubarb, and Swiss chard, oxalates stick to calcium and make it hard for the body to use. For example, only about 5% of the calcium in spinach can be absorbed, so foods high in oxalates should not be counted as main sources of calcium.
- Phytic acid (phytates): Found in whole grains, beans, nuts, and seeds, phytates also can stop calcium, iron, and zinc from being absorbed, but not as strongly as oxalates. Soaking, sprouting, or fermenting cuts down phytate content and helps your body use these minerals better.
These chemicals don’t stop your body from using calcium from other foods in the same meal. It’s best to eat a variety of calcium-rich foods-like calcium-set tofu, fortified plant milks, and low-oxalate greens-to get enough that your body can use.
How much calcium and vitamin D do vegetarians need every day?
Vegetarians and vegans need about the same daily amounts of calcium and vitamin D as those who eat meat:
- Calcium: 1,000 to 1,200 mg for most adults (age, menopause, and other factors may raise needs)
- Vitamin D: 600 IU for adults up to age 70, and 800 IU for those older than 70
It can be tougher for vegetarians and vegans to reach these targets because they skip some animal foods and some plant foods block calcium absorption. Focus on:
- Calcium-fortified plant milks, orange juice, cereals
- Calcium-set tofu
- Low-oxalate greens like kale and bok choy
- Beans, nuts, and seeds
- Supplements for vitamin D, especially in low-sunlight locations or winter
Planning meals with these foods and adding supplements as needed helps vegetarians and vegans meet their daily needs for strong bones.
Summary: How to maintain healthy bones on a vegetarian diet
Keeping bones healthy on a vegetarian or vegan diet is possible with the right choices. The main thing is not to avoid animal products blindly, but to replace them wisely. Bone health comes from having enough calcium, vitamin D, protein, and other nutrients that are sometimes less common in plant foods.
Make meal plans that include many different calcium-rich and protein-rich plant foods, pay attention to foods that make it harder to absorb minerals, and use fortified foods or supplements for vitamin D and B12 when needed. Regular exercise, avoiding smoking and excess alcohol, and keeping a healthy weight are just as important. With planning and attention to these points, vegetarian and vegan diets can support bone health just as well as diets that include animal products.
