Comparative fracture risk in vegetarians and nonvegetarians in EPIC-Oxford.
OBJECTIVE
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).


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


METHODS
The United Kingdom.


METHODS
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.


METHODS
Cox regression.


RESULTS
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.


CONCLUSIONS
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.


BACKGROUND
The EPIC-Oxford study is supported by The Medical Research Council and Cancer Research UK.
Appleby
P
P
Cancer Research UK Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK. paul.appleby@ceu.ox.ac.uk
Roddam
A
A
Allen
N
N
Key
T
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000008:administration & dosage*; D002136:Calcium, Dietary / Q000008:administration & dosage*; D015331:Cohort Studies; D016001:Confidence Intervals; D014676:Diet, Vegetarian; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008460:Meat; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D017747:Seafood
D050071:Bone Density Conservation Agents; D002136:Calcium, Dietary