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Comparative fracture risk in vegetarians and nonvegetarians in EPIC-Oxford



To compare fracture rates in four diet groups (meat eaters, fish eaters, vegetarians and vegans) in the Oxford cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Oxford).


Prospective cohort study of self-reported fracture risk at follow-up.


The United Kingdom.


A total of 7947 men and 26 749 women aged 20–89 years, including 19 249 meat eaters, 4901 fish eaters, 9420 vegetarians and 1126 vegans, recruited by postal methods and through general practice surgeries.


Cox regression.


Over an average of 5.2 years of follow-up, 343 men and 1555 women reported one or more fractures. Compared with meat eaters, fracture incidence rate ratios in men and women combined adjusted for sex, age and non-dietary factors were 1.01 (95% CI 0.88–1.17) for fish eaters, 1.00 (0.89–1.13) for vegetarians and 1.30 (1.02–1.66) for vegans. After further adjustment for dietary energy and calcium intake the incidence rate ratio among vegans compared with meat eaters was 1.15 (0.89–1.49). Among subjects consuming at least 525 mg/day calcium the corresponding incidence rate ratios were 1.05 (0.90–1.21) for fish eaters, 1.02 (0.90–1.15) for vegetarians and 1.00 (0.69–1.44) for vegans.


In this population, fracture risk was similar for meat eaters, fish eaters and vegetarians. The higher fracture risk in the vegans appeared to be a consequence of their considerably lower mean calcium intake. An adequate calcium intake is essential for bone health, irrespective of dietary preferences.


The EPIC-Oxford study is supported by The Medical Research Council and Cancer Research UK.

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The EPIC-Oxford study is supported by The Medical Research Council and Cancer Research UK. We thank the participants in EPIC-Oxford.

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Correspondence to P Appleby.

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Guarantor: P Appleby.

Contributors: PA performed the statistical analyses and wrote the manuscript. AR and NA contributed to the design of the study, interpretation of the results and to the writing of the manuscript. TK is the principal investigator of the EPIC-Oxford study and contributed to the manuscript writing.

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Appleby, P., Roddam, A., Allen, N. et al. Comparative fracture risk in vegetarians and nonvegetarians in EPIC-Oxford. Eur J Clin Nutr 61, 1400–1406 (2007).

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  • fracture risk
  • diet
  • vegetarian
  • vegan
  • prospective study
  • EPIC-Oxford

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