Get the brief

The Evidence

Page 05

Calcium and bone health on a vegan diet

This is the page where being on veganism's side means telling you the uncomfortable finding: vegans break more bones in the data, and calcium is the lever that moves it.

Vegan Brief Evidence last reviewed July 2, 2026

This is a summary of the cited evidence, not medical advice.

  • Fracture risk Higher only when calcium is low
  • The lever Adequate calcium
  • Evidence EPIC-Oxford cohort

The intake gap

Dairy is the dominant calcium source in most diets, so cutting it out has a predictable effect. The NIH fact sheet, public domain, lists exactly who is at risk.

Primary source 01 / 06

People with lactose intolerance, those with an allergy to milk, and those who avoid eating dairy products (including vegans) have a higher risk of inadequate calcium intakes because dairy products are rich sources of calcium

NIH Office of Dietary Supplements US National Institutes of Health Calcium: Fact Sheet for Health Professionals, 2024

Plant calcium exists, but it is not always well absorbed, which the same sheet spells out.

Primary source 02 / 06

The absorption of calcium varies depending on the type of food; absorption from dairy products and fortified foods is about 30%, while absorption from certain plants may be much lower due to the presence of compounds that form indigestible salts with calcium.

NIH Office of Dietary Supplements US National Institutes of Health Calcium: Fact Sheet for Health Professionals, 2024

What the fracture data shows

This is not just a nutrient-on-paper question. The EPIC-Oxford study followed tens of thousands of people in the UK and recorded actual fractures. The finding is not the flattering one.

Primary source 03 / 06

Non-meat eaters, especially vegans, had higher risks of either total or some site-specific fractures, particularly hip fractures.

Tong and colleagues University of Oxford, BMC Medicine EPIC-Oxford fracture study, 2020

In numbers the study reports: compared with meat eaters, vegans had a hip-fracture hazard ratio of 2.31, which worked out to 14.9 more hip-fracture cases per 1000 people over 10 years. The authors point to calcium and protein as part of the reason.

Primary source 04 / 06

In this study and previous studies, vegans had substantially lower intakes of calcium than other diet groups since they do not consume dairy, a major source of dietary calcium

Tong and colleagues University of Oxford, BMC Medicine EPIC-Oxford fracture study, 2020

And the risk moved when they accounted for calcium, which is the actionable part.

Primary source 05 / 06

The associations were attenuated further but remained significant in vegans with additional adjustment for dietary calcium

Tong and colleagues University of Oxford, BMC Medicine EPIC-Oxford fracture study, 2020

The authors are careful not to oversell an observational result.

Primary source 06 / 06

This is the first prospective study of diet group with both total and multiple specific fracture sites in vegetarians and vegans, and the findings suggest that bone health in vegans requires further research.

Tong and colleagues University of Oxford, BMC Medicine EPIC-Oxford fracture study, 2020

The takeaway is not scary, it is specific. Hit your calcium target from fortified plant milks, tofu set with calcium, and low-oxalate greens, and get enough protein. The finding that vegans fracture more is real. So is the finding that calcium narrows the gap.

  • Plant-based diets and heart disease The heart-disease evidence is genuinely good for plant-based eating, and honest reporting includes the one finding that cut the other way: stroke.
  • Vegan diets in pregnancy and childhood This is the page to get right, so it is the page with the most hedging. The dietitians' body says a planned vegan diet works at every life stage. The same sources say B12 is not optional.
  • Vitamin D on a vegan diet Vitamin D is the one almost everyone runs low on in winter, vegan or not. The plant-friendly fix is D2 or lichen D3, plus fortified foods and sensible sun.
  • Plant-based diets, bone health and fracture risk Publishing the unflattering finding is the point: in the best cohort, vegans broke more bones. The risk is real, it mostly tracks calcium, protein and body weight, and it is fixable.
  • Vitamin K and K2 on a vegan diet Vitamin K1 is one of the easiest nutrients to get on a plant diet: it is what makes leafy greens green. K2 is the one people worry about, and the honest answer involves natto, gut bacteria, and your own biology.
  • Magnesium on a vegan diet Magnesium is one of the easier minerals to get on a plant diet, because its best sources are exactly the foods a good vegan diet is built on.
  • Is Vitamin D3 (cholecalciferol) vegan? Is it vegan? · Vitamin D3 is usually made from lanolin in sheep's wool, but a lichen-derived vegan D3 exists, and D2 is plant-based. Check the label or ask.
  • Is Calcium carbonate (chalk, E170) vegan? Is it vegan? · Calcium carbonate is chalk, essentially, quarried from rock to firm, whiten and fortify. It is a mineral, so it sits on the vegan side, with a rare shell-derived footnote.

Frequently asked

Do vegans have a higher risk of fractures?

In the EPIC-Oxford study, non-meat eaters, especially vegans, had higher risks of total and some site-specific fractures, particularly hip fractures. Vegans had a hip-fracture hazard ratio of 2.31 compared with meat eaters.

Does calcium intake reduce that risk?

The study authors found the fracture associations were attenuated with adjustment for dietary calcium, and note that vegans had substantially lower calcium intakes because they do not consume dairy. Meeting calcium targets from fortified and plant sources is the practical response.

The primary sources

The documents this page quotes. Read them yourself.

Evidence first, every morning.

The standard behind these pages, applied to each day’s news: the study quoted and graded before the headline reaches you. One short brief, free.

Free, every morning. No guilt. No preaching.