There was a recent post about a study that purported to show that vegetarians and vegans had higher hip fracture risk. However, that study only adjusted for Vitamin D intake and not calcium. You’d think that might be key. Furthermore, the study was of a random cohort and not one necessarily eating a healthy diet.
How about the healthiest cohort of all, from the bluest of the Blue Zones? Here is a study on the Adventist Health Study 2 cohort, and its findings:
[Dietary patterns and hip fracture in the Adventist Health Study 2: combined vitamin D and calcium supplementation mitigate increased hip fracture risk among vegans](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8435998/)
> **Men**
> No association was found between diet pattern and hip fracture risk in age-adjusted analyses. Multivariable analysis and stratification on supplementation with vitamin D and/or calcium did not change these findings.
> **Women**
> There was a significant association of diet pattern with hip fracture, with a higher proportion of cases among those consuming a plant-based diet. The incidence of hip fracture per 1000 PYRS was 3.9 and 2.4 for vegans and NVEGs, respectively.
*[Note: Think about the absolute difference first, especially compared to the other risks of not being WFPB. The NNT (number needed to treat) is 66.7. 66.7 people would have to stop being vegan in order for one of them to avoid a hip fracture.]*
> Multivariable analyses did not change the findings substantially. However, interactions between diet pattern and calcium or vitamin D supplement intake alone or together in multivariable models were each significant. Table 5 shows the multivariable association between diet pattern and hip fracture in the various subgroups of those taking no supplement, only a calcium supplement, or both supplements. Vegan women who consumed neither supplement had almost 3 times the risk of hip fracture relative to NVEG women (HR: 2.99; 95% CI: 1.54, 5.82; P-trend = 0.006). **In contrast, among those with calcium *and* vitamin D supplementation combined, no increase in risk of hip fracture was found across dietary patterns (P-trend = 0.78).** Among those who only supplemented with calcium, there was a nonsignificant increased risk for all vegetarian dietary patterns, with pesco-vegetarians and vegans having the highest HRs of 1.88 and 1.62, respectively, but no significant trend was found across the diet categories (P-trend = 0.36).
> In the current study, mean dosage of each supplement differed little by pattern: ∼660 mg Ca/d and ∼13.5 μg vitamin D/d. However, *the proportion of vegans using both supplements (32%) was significantly lower than for the other patterns (∼50%).* When comparing dietary intakes among women, *a vegan pattern was associated with significantly lower intakes of calcium and vitamin D and with an increased risk of hip fracture compared with an NVEG diet. However, the vegan diet, when supplemented with both calcium and vitamin D, was associated with the same risk as or a lower risk of fracture than NVEG or the other diet categories.* **Our results therefore suggest that both vitamin D and calcium are independently important and necessary for an optimal vegan diet.**
So, just get your Calcium and D and there’s nothing to worry about. Eat your leafy greens.
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