Bone Health for Vegans and Vegetarians: A UK Guide

Does a vegan or vegetarian diet raise your risk of bone fractures?

Yes — the largest UK study to look at this found higher fracture risk in vegans and vegetarians than in meat-eaters, but the picture is more manageable than the headlines suggest. The EPIC-Oxford study followed 54,898 UK adults for a mean of 17.6 years and recorded 3,941 fractures. Compared with meat-eaters, vegans had a 43% higher risk of total fractures (hazard ratio 1.43, 95% CI 1.20–1.70) and more than double the risk of hip fracture (HR 2.31, 95% CI 1.66–3.22) BMC Medicine, 2020.

Vegetarians were affected less. In the same study, vegetarians had a higher hip-fracture risk than meat-eaters (HR 1.25, 95% CI 1.04–1.50) BMC Medicine, 2020. Put in absolute terms, the differences in hip fracture worked out to roughly 2.9 extra cases per 1,000 people over 10 years for vegetarians and about 14.9 extra cases per 1,000 for vegans BMC Medicine, 2020. Real, but not the kind of number that makes a well-planned plant-based diet unsafe.

Why do plant-based diets carry higher fracture risk — and can you avoid it?

Much of the extra risk tracks with three modifiable things: lower calcium intake, lower protein intake, and often a lower body weight — all of which you can address. The EPIC-Oxford analysis found that adjusting for body mass index (BMI) attenuated the associations, which points to lower average body weight as part of the story; being underweight is itself a recognised risk to bone BMC Medicine, 2020.

The reassuring part is that the leading UK bone charity and dietitians agree this is a planning problem, not a fundamental flaw in plant-based eating. The Royal Osteoporosis Society states plainly that a vegan diet is compatible with good bone health with informed choices — it is easy to hit your calcium target without dairy, and good-quality plant protein spread through the day supports bone Royal Osteoporosis Society, 2024. In other words, the nutrients most linked to the risk are exactly the ones a thoughtful plant-based diet can cover. If you want the wider picture of what erodes bone over time, see our explainer on what causes osteoporosis.

How much calcium do you need, and how do you get it without dairy?

Adults aged 19–64 need 700mg of calcium a day, and you can reach that comfortably on a plant-based diet. That figure comes from the NHS, which notes calcium helps build bone and keep teeth healthy, and that most people can get enough from their daily diet NHS, 2024.

Without dairy, the NHS lists plant calcium sources including fortified soya, pea and oat drinks, calcium-set tofu, sesame seeds and tahini, brown and white bread, dried fruit and green leafy vegetables — but specifically not spinach NHS, 2024. The British Dietetic Association adds fortified plant milks (soya, almond, oat), dried fruits such as figs, leafy greens like kale and broccoli, almonds and sesame to the same list British Dietetic Association, 2024.

Two absorption points are worth knowing:

• Fortified plant milks broadly match cows' milk for calcium, and the Royal Osteoporosis Society says it is easy to hit your calcium target without dairy when you choose fortified alternatives and calcium-set tofu Royal Osteoporosis Society, 2024.
• Some plant compounds reduce absorption. The oxalates in spinach and Swiss chard, and the phytates in grains and legumes, lower how much calcium your body takes up — soaking and boiling legumes helps Royal Osteoporosis Society, 2024. This is why spinach, despite its reputation, is a poor calcium source, and why variety matters. For a fuller food-by-food breakdown, see our guide to the best foods for bone health.

How much protein do you need, and what are the best plant sources?

Protein forms the scaffold that bone minerals bind to, so spreading good-quality plant protein through the day is a core part of protecting your bones. The Royal Osteoporosis Society advises eating good-quality plant protein throughout the day rather than concentrating it in one meal Royal Osteoporosis Society, 2024.

For sources, both UK bodies point to the same staples. The Royal Osteoporosis Society lists beans, peas, lentils, tofu, tempeh and seitan as good plant protein Royal Osteoporosis Society, 2024, and the British Dietetic Association adds Quorn alongside beans, peas, lentils, tofu, tempeh and seitan British Dietetic Association, 2024. Many of these — tofu, tempeh, beans and lentils — pull double duty by contributing calcium as well as protein, which is exactly the pairing the fracture data suggests plant-based eaters should prioritise. Our companion piece on vitamin D, calcium and protein for bone health covers how these three nutrients depend on each other.

Do vegans need a vitamin D supplement in the UK?

Almost everyone in the UK should consider a daily 10 microgram vitamin D supplement in autumn and winter — and for vegans, choosing a plant-suitable version is the only extra step. The NHS advises that adults need 10 micrograms of vitamin D a day, that everyone should consider a daily 10 microgram supplement during autumn and winter, and that vitamin D helps regulate calcium and phosphate to keep bones, teeth and muscles healthy NHS, 2024.

Both UK bodies extend this to plant-based eaters specifically. The Royal Osteoporosis Society states that all UK residents should consider vitamin D supplementation in autumn and winter Royal Osteoporosis Society, 2024, and the British Dietetic Association says everyone in the UK should take a 10 microgram vitamin D supplement, especially in winter British Dietetic Association, 2024. Not all vitamin D supplements are vegan, so look for a vegan-suitable one — lichen-derived vitamin D is a common option.

Do you need a vitamin B12 supplement on a plant-based diet?

Vitamin B12 occurs naturally almost only in animal foods, so vegans need it from fortified foods or a supplement — this is not optional. The NHS notes that B12 sources are limited for vegans because it is found naturally in animal foods, so a supplement or fortified foods may be needed NHS, 2024. The British Dietetic Association points to fortified dairy alternatives, nutritional yeast and fortified cereals, or a supplement British Dietetic Association, 2024.

B12 supports healthy nerves and blood, and while it is not a bone mineral, a well-rounded plant-based diet that covers it is part of eating well for long-term health. For the right amount or product for you, speak to your GP or a registered dietitian rather than guessing.

Should you avoid going vegan to protect your bones?

No — the evidence does not support that, and the more useful response is to plan a bit more carefully. The EPIC-Oxford authors did not advise against plant-based diets, and the higher fracture risk they observed appears manageable with attention to a handful of nutrients and to body weight BMC Medicine, 2020. The practical checklist is short: hit your 700mg calcium target through fortified foods and calcium-set tofu, spread good-quality protein through the day, take a vitamin D supplement (especially in winter), cover B12, and keep to a healthy body weight, since being underweight itself weakens bone.

Where a plant-based diet is well planned, both the Royal Osteoporosis Society and the British Dietetic Association agree it is compatible with good bone health Royal Osteoporosis Society, 2024. If you would like to know where your bones actually stand — rather than relying on hope — a radiation-free REMS scan can establish a baseline and help you monitor your bone health over time, complementing rather than replacing your GP's care. You can learn more about our bone health assessment, which is well suited to safe, repeat monitoring as you fine-tune your diet.

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This article is part of our bone health series. For more on the nutrients that build and protect bone, see our guide to vitamin D, calcium and protein for bone health.