6 real-life questions about vegan diets and bone health, answered

Whether you choose to go vegan because of environmental, animal welfare or health and lifestyle reasons, it’s good to learn more about how it might affect your bones.

We asked our friends at The Vegan Society to share some of the most common bone health-related questions asked by their members. And we caught up with members of our own Community Advocate Network (CAN) to see how they get all the nutrition they need for their bones while following a plant-based diet.

1. “Do vegans have a greater risk of bone fractures than non-vegans?”

“Previous research, namely the Plant-based diets and long-term health: findings from the EPIC-Oxford study suggested that vegans have a higher risk of fractures (broken bones) than those following a vegetarian or omnivorous diet. However, the relationship between our dietary choices and bone health is not that simple,” says The Vegan Society dietitian Emily McKee.

“Some recent studies have since found that vegans with a ‘healthful, well-planned' diet containing regular consumption of whole grains, fresh fruit and vegetables, nuts and legumes, did not have lower bone density or increased risk of fractures compared to vegetarians or omnivores. In fact, they found that healthy plant-based diets reduced the risk of osteoporosis by 36%, whereas an unbalanced plant-based diet increased risk by 41%.

“These studies cannot however confirm whether reduced fracture risk is associated with nutritional properties of a healthy plant-based diet, or because people who eat this way are generally more health conscious.”

We took a deeper dive into the research surrounding plant-based diets and bone health in our recent Bone Matters session with Professor Susan Lanham-New.

2. “Do plant-based foods block calcium absorption?”

“Some vegetables such as spinach and Swiss chard contain compounds called oxalates that can reduce the amount of calcium your body absorbs. This doesn’t mean we should stop eating these vegetables, but it is important that we are also including rich sources of calcium in our diet to counteract this,” explains Emily.

“Phytates are another compound causing the same effect on calcium absorption, found in some grains and legumes such as beans and lentils. Soaking legumes overnight and boiling in fresh water can reduce their phytate content.”

3. “I’m going through the menopause, how will this affect my bone health?”

“There are a few bodily changes that can influence bone health during the menopause. Oestrogen losses increase the rate of calcium lost from our bones, which is why calcium intake is so important, and those going through the menopause should aim for at least two to three rich sources daily,” says Emily.

“During the menopause muscle mass also reduces, which may lead to weight gain and affect bone health. A mix of resistance (e.g. weight training) and weight-bearing exercise (e.g. yoga) with impact (e.g. jogging) can help preserve and build muscle mass, supporting bone health and balance.”

You can find out more about the connection between menopause and bone health here.

4. “I don’t want to get calcium from plant-based drinks (PBDs) as they are ultra-processed but what’s the alternative?”

“Whilst PBDs can be considered ‘ultra-processed’, the term itself is not very helpful for classifying the health or nutritional profile of foods. The British Nutrition Foundation recommends choosing products that are lower in salt, sugar and saturated fat rather than basing decisions on its level of processing,” says Emily.

“Although some ultra-processed foods, such as sugar-sweetened drinks and refined carbohydrates, have been associated with increased risk of developing long-term health conditions, recent research found no link between consuming plant-based dairy alternatives and the likelihood of developing cardiovascular disease, cancer or diabetes over a 10-year follow-up period.

“The processing involved in PBDs includes fortification with additional vitamins and minerals such as calcium, iodine and vitamin D. This is a beneficial process that increases the nutritional value of the final product.

“If you choose to avoid PBDs, you can still get calcium from other sources including calcium-set tofu, fortified oats and cereals, tahini, almonds and watercress.”

CAN member Vijay, 66, adds ‘Barley Cup cereal drink, calcium & vitamins’ to his bedtime cup of milk as an extra source of calcium and vitamin D.

“It’s vegan, caffeine free and tastes like mild coffee,” he explains. “Horlicks is rich in calcium, vitamin D and protein. Its vegan version is a good source of calcium and vitamin D, too, although its protein content is considerably less than Horlicks original.”

5. “I have coeliac disease – how will this impact my bone health?”

Some health conditions that affect the way your body absorbs food, such as Crohn’s or coeliacs disease, can increase your risk of osteoporosis and fractures.

“Coeliac disease is a condition where the body’s immune system attacks its own tissues when you eat gluten, leading to damage to the lining of your gut,” says Emily.

“This might mean you absorb some nutrients less efficiently if damage has occurred, and so calcium requirements are higher. Eating at least three rich sources of calcium daily can help to hit your target.”

You can read more about eating vegan and gluten-free on a budget on The Vegan Society's website.

6. “How can I get enough protein on a vegan diet?”

“The key thing is to eat a balanced and varied diet that provides adequate calories and features meals containing sources of good-quality protein such as peanuts, pumpkin seeds, beans, peas, lentils and tofu,” says Emily.

“Some wholegrains, like quinoa, amaranth, buckwheat, wild rice and popped corn, can also make useful contributions to our protein intakes.

“Those with higher protein needs might also want to consume more protein-dense options in their diet, such as soya beans, tofu, tempeh, soya mince, seitan and vegan Quorn^TM.”

Tofu is something that CAN member Linda, 63, has worked into her vegan diet. “Tofu is a good protein and calcium source, great in stir fries, curries and scrambled,” she explains.

“Beans, lentils, nuts and quinoa are also protein packed. I try to eat a rainbow of fruit and vegetables plus wholegrains like brown rice, wholemeal bread and pearl barley.”

Read our Further Food Facts fact sheet to learn more about what our bones need, beyond calcium and vitamin D.