Do vegan and vegetarian women break more bones?

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It is not the first time that science has spoken of the

diet

.

Numerous studies have been published on vitamin B12 deficiency and homocysteine ​​levels, which are often elevated in vegans, contributing to disease.

Several studies even show lower bone density and higher risk of fractures in vegans compared to omnivores.

Now, a new report has once again generated

, especially on social media, and numerous headlines in the press.

This is an observational study carried out in

for just over two decades among 26,318 women aged 35 to 69 years.

It concludes that those who base their diet on vegetables can have

, although it recognizes that more research is needed in this regard.

Specifically, it associates this diet with a 33% higher risk of suffering a hip fracture compared to women who consume meat about five times a week.

THE DETAILS OF THE STUDY

The problem in a simple look at the study, from the outset, is the enormous complexity when it comes to

and a causal relationship.

Since, in this 3% of women who broke their hip of the total number of participants, the data is observational and the risk of fracture did not vary much between those who ate meat frequently and those who did so in smaller quantities or only ate fish.

Nor is it distinguished between

(who add animal derivatives to the plate, such as eggs or milk), nor is it specified if they change their diet at any time in the 22 years of observation.

It should also be borne in mind that women suffer from

during menopause, which can accelerate the loss of bone mass.

For all these reasons, this 33% higher risk of fracture should be grasped with tweezers.

We question the experts on their own conclusions after reviewing the document.

We also wonder if the solution lies in abandoning this type of diet since, in other studies, vegetarianism and veganism are associated with positive aspects for health, such as lower cardiovascular risk and metabolic diseases.

ARGUMENTS OF THE SPECIALISTS

Dr. Borja Alcobía Díaz, Medical Specialist in Orthopedic Surgery and Traumatology, and member of the Knee Surgery Unit of the Orthopedic Surgery and Traumatology Service of the San Carlos Clinical Hospital in Madrid, highlights two main strengths in this article.

On the one hand, "it is the first prospective study with

with such a long follow-up period".

In addition, the results are based "on the records stored in a

, compared to other studies that obtain them from data obtained by the patients themselves", which could lead to a lack of information, he justifies.

However, it also perceives certain shortcomings, which it lists below:

• The population sample is of

  a younger age

  (53 years), compared to the average 83 years in which hip fractures occur in the same population.

• It does not differentiate the high-energy traumatic origin

  of the fracture (more frequent in young people, as in this series), compared to the low-energy or fragility fractures, which are those related to osteoporosis that the article aims to relate as a result of the decrease of bone strength.

• There is a double selection bias.

  Those people who respond to the acceptance of answering a series of questionnaires and giving consent to their follow-up are included in the study evaluation.

  Usually these

  more proactive patients

  tend to be more careful with their health, and I would rule out other patients who, regardless of their diet, have less control over their health.

  Even more so than those accepted at the beginning, those who do not provide the information are discarded, the exclusion of patients less attentive to their health status being even clearer.

• It does not differentiate vegans from vegetarians (although it says that most are vegetarians).

• It

  focuses on hip fracture

  , leaving aside other types of fractures considered fragility, such as fractures of the proximal humerus and distal radius.

• It does not provide

  changes in the diet

  of the patients studied in the more than 20 years that the study lasted.

• The vast majority (98.8%) are white women.

  So the ethnic factor can influence.

• Diet data is based on self-

  administered responses

  to questionnaires by the patients studied.

• It does not take into account certain confounding factors, since, for example, not only the body mass index (BMI), but also the body composition in terms of percentage of

  fat and lean mass

  may be related.

  Since, for example, patients with greater fat mass within a normal BMI can better cushion falls and fat tissue, increase the level of estrogen (hormone related to the protection of bone tissue), as well as decreased levels of IGF-1 ( insulin-like growth factor-1) associated with low BMI levels.

The main finding of the study is that vegetarian women were a third more likely to break their hip.

AT THE NUTRITIONAL LEVEL

Given that there is an ever-increasing percentage of the population interested in vegetarian and even vegan diets for

, we also asked Natalia Hernández Carrillo, a Vivolabs nutritionist who graduated from the Complutense University of Madrid, in what can affect the follow-up of a diet free of meat and derivatives of animal origin.

"It must be made clear that any health professional, according to scientific evidence, must recognize that a vegetarian or vegan diet is healthy. Of course, this is the case if it is well designed and prescribed by a specialized professional," she points out.

From the point of view of the nutritionist, many people are not consistent, at an educational level, of how much food can influence health.

"Several studies like this one have shown that certain people on vegan/vegetarian diets have

that are generally found to a greater extent in foods of animal origin. The article doesn't lie."

Now, this deficit occurs when people forget to have a variety of foods or to look for plant sources of these nutrients, such as protein, she explains.

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"Another

to match intake is enough."

A simple example is 100 grams of meat, which would have about 30 grams of protein, while 100 grams of broccoli would have about 3.5 grams.

The point is that, whether it is a vegan, vegetarian or omnivorous diet, it has to be adequate and balanced, the expert points out.

"Because education on these fronts is not always optimal, it can be practiced by some people in harmful ways."

Regarding the

that so many studies indicate, Hernández Carrillo points out that this is the only micronutrient that is insufficiently found in plant-based foods.

"The supplementation of other compounds could be recommended under professional supervision. In addition, it is always necessary to consume more foods rich in the nutrient that is lower, regardless of the diet that is followed."

IN CONCLUSION

It is a study of high scientific quality, with long follow-up, cites the doctor.

"The conclusions

, such as a diet poor in animal protein, which may be related to the increased risk of suffering a hip fracture," says Alcobía Díaz.

And that, without a doubt, should be studied in greater depth.

"Study design that

is needed to categorically state the fact that all non-meat and non-fish eaters are at increased risk of hip fracture."

For the nutritionist, the study should not alarm or condition vegan or vegetarian people.

"Knowledge is the only way to

."

Any type of diet, understood as the daily intake menu, must be balanced and adapted to the needs of each person, without being done lightly, alert.

What worries the Vivolabs professional the most is the lack of general information and the absence of implementation of urgent measures by the institutions.

"Until

, part of the population will continue to lack good resources to avoid these feeding errors," she asserts.

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