A vegetarian diet increased the risk of hip fracture in women by 33% in a study recently published in BMC Medicine. The study is one of very few to compare risk of hip fracture in vegetarians and meat-eaters where the occurrence of hip fracture was confirmed from hospital records. The study authors contend that because the number of vegetarians worldwide is increasing (Iguacel et al, 2019), understanding hip fracture risk in vegetarians in particular is becoming increasingly important to public health.

The study used data from the UK Women’s Cohort, established at the University of Leeds, to explore links between diet and hip fracture risk.

Women’s special risk

Approximately 5% of people in the United States are vegetarians (Gallup, 2018), the majority of whom are women (Rosenfeld, 2018, Ruby, 2012). According to the Centers for Disease Control and Prevention (CDC), women fall more often than men and more often suffer from osteoporosis, a disease that weakens bones and makes them more likely to break. And while not all falls result in an injury, about 37% of those who fall reported an injury that required medical treatment or restricted their activity for at least one day, resulting in an estimated 8 million fall injuries. In fact, CDC data reveals that women experience three-quarters of all hip fractures.

“Hip fracture is a global health issue with high economic costs that causes loss of independence, reduces quality of life, and increases risk of other health issues,” according to study co-author Professor Janet Cade, leader of the Nutritional Epidemiology Group in the School of Food Science and Nutrition at the University of Leeds.

26,318 women, 822 hip fracture cases over ~20 years

For this study, more than 26,000 UK-based women were classified by researchers as regular meat-eaters (eating ≥ 5 servings/week), occasional meat-eaters (eating < 5 servings/week), pescatarians (eating fish but not meat), or vegetarians (eating neither meat nor fish). Data was gathered from study participants based on a validated 217-item food frequency questionnaire completed in the years 1995 to 1998. At the time they were recruited into the cohort study, the women ranged in age from 35 to 69 years.

Incident hip fractures among the women were identified via Hospital Episode Statistics up to March 2019.

The data reflected 822 hip fracture cases among study subjects. After adjustment for confounders, women who were vegetarians—but not occasional meat-eaters or pescatarians—had a greater risk of hip fracture than regular meat-eaters.

The BMI linkage

“The observed higher risk of hip fracture in vegetarians compared to regular meat-eaters may be partly explained by the differences in body anthropometrics between the diet groups,” wrote the researchers. That is, the study found that the average body mass index (BMI) among the vegetarian women was slightly lower than the average among the regular meat-eating women and previous research has shown a link between low BMI and a high risk of hip fracture.

A concern, but ‘not a warning’

Lead author James Webster, a doctoral researcher at the School of Food Science and Nutrition at the University of Leeds, stated in an accompanying press release: “Our study highlights potential concerns regarding risk of hip fracture in women who have a vegetarian diet. However, it is not warning people to abandon vegetarian diets. As with any diet, it is important to understand personal circumstances and what nutrients are needed for a balanced healthy lifestyle.”

Further research is needed to confirm the study’s findings in other populations, such as men and non-European populations, noted the authors, and to identify the factors responsible for the observed risk difference between vegetarians and meat-eaters.

A downloadable PDF of complete study findings from “Risk of hip fracture in meat-eaters, pescatarians, and vegetarians: results from the UK Women’s Cohort Study,” can be found at no cost at https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-022-02468-0

CLINICIANS’ BONUS: MORE TO KNOW

Resources for you and your patients

FOR YOU

As a healthcare provider, you can use CDC’s Stopping Elderly Accidents, Deaths & Injuries (STEADI) initiative to help reduce fall risk among your older patients. The site contains a wealth of clinical and patient education resources to help you integrate fall prevention into routine clinical practice. Of special note is the free continuing education credits available for completion of the STEADI: Empowering Healthcare Providers to Reduce Fall Risk training, as well as a downloadable pamphlet, “Postural Hypotension, What It Is and How to Manage It,” to teach patients how to manage their postural hypotension. Finally, don’t miss this fact sheet, “Older Adult Falls: A Growing Problem That Can Be Prevented,” which highlights information about how falls threaten older adults’ health, independence & quality of life. Most of the CDC resources are also available in Spanish and many are available for you to customize with your practice name prior to distribution to your patients.

FOR YOUR PATIENTS

At this link, CDC also provides a brochure for family caregivers with steps to help prevent older adult falls, a home fall prevention checklist to encourage patients to help identify and eliminate fall hazards in their home, and a chair rise exercise sheet containing simple, illustrated exercises to help improve patients’ thigh and buttock strength in order to reduce fall risk.