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Osteoporosis is a commonly occurring metabolic bone disease characterized by a reduction in bone mineral density (BMD) and the deterioration of bone microarchitecture, frequently leading to increased risk of bone pain and fragility fractures. This disease affects over 200 million individuals globally, and its incidence continues to rise annually, particularly among middle-aged and elderly populations. The annual medical cost of osteoporosis-related fractures in the United States alone is estimated to be around $17.9 billion annually, imposing a heavy economic burden. Consequently, preventing osteoporosis has become a significant public health concern. In addition, although medication is an effective treatment for osteoporosis, the percentage of patients receiving medication treatment remains low due to the fragmented nature of the healthcare system and concerns about medication side effects. Lifestyle changes, such as increasing physical activity and modifying dietary habits, may provide a more feasible and effective approach to improving bone health.
Plant-based dietary patterns, characterized by higher intake of plant foods and lower consumption of animal foods, have been widely recommended as healthy dietary options. A plant-based diet has been shown to improve the diversity and composition of the intestinal microbiota, leading to increased production of specific metabolites that exert beneficial effects on host health, including at the intestinal and systemic levels. Accumulating evidence suggests that a plant-based diet plays a positive role in preventing chronic diseases such as type 2 diabetes mellitus (T2DM), hypertension, and cardiovascular disease. However, a plant-based diet has been found to include lower levels of calcium, vitamin D, vitamin B-12, protein, and n-3 fatty acids, which are all crucial for maintaining bone health. As a result, individuals following plant-based diets may exhibit lower BMD and higher risk of fractures. In a recent study of participants in the 2007–2010 National Health and Nutrition Examination Survey (NHANES), self-identified vegetarians had significantly lower BMD than non-vegetarians. Additionally, a meta-analysis found that individuals following a plant-based diet exhibited lower BMD and higher rates of fractures in the femoral neck and lumbar spine than those following an omnivorous diet. Consequently, caution should be exercised when transitioning from an animal-based diet to a plant-based diet, particularly for individuals shifting towards a vegan diet.
Researchers at Fudan University in China analyzed data from 16,085 adult Americans who participated in the National Health and Nutrition Examination Survey [NHANES] between 2005 and 2018.
The researchers had access to scans that told how the bone mass of the study participants changed during the study. Thanks to interviews, the researchers also had an idea of the diet of the study participants and assigned the study participants 3 different scores on the basis of this.
One score was the plant-based diet index [PDI]. It is higher if someone eats more vegetable products and less animal products.
A second score was the healthy plant-based diet index [hPDI]. This is higher if a diet contains more healthy plant foods, such as vegetables, nuts, fruit and other whole products.
A third score was the unhealthy plant-based diet index [uPDI]. This is higher if there are more unhealthy vegetable products in the diet, such as foods with a lot of refined carbohydrates and sweetened juices.
A first group [AL] was allowed to eat as much and whenever they wanted. This was the control group. The mice in the other 5 groups received 70 percent of the food consumed by the mice in the AL group. The mice in these 5 groups were thus exposed to caloric restriction.
Results
The higher the study participants scored on the healthy plant-based diet index [hPDI] and the plant-based diet index [DPI], the greater their risk of osteopenia. Osteopenia is a precursor to osteoporosis.
High scores on the unhealthy plant-based diet index [uPDI] increased the risk of osteoporosis.
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Plant-based dietary patterns, characterized by higher intake of plant foods and lower consumption of animal foods, have been widely recommended as healthy dietary options. A plant-based diet has been shown to improve the diversity and composition of the intestinal microbiota, leading to increased production of specific metabolites that exert beneficial effects on host health, including at the intestinal and systemic levels. Accumulating evidence suggests that a plant-based diet plays a positive role in preventing chronic diseases such as type 2 diabetes mellitus (T2DM), hypertension, and cardiovascular disease. However, a plant-based diet has been found to include lower levels of calcium, vitamin D, vitamin B-12, protein, and n-3 fatty acids, which are all crucial for maintaining bone health. As a result, individuals following plant-based diets may exhibit lower BMD and higher risk of fractures. In a recent study of participants in the 2007–2010 National Health and Nutrition Examination Survey (NHANES), self-identified vegetarians had significantly lower BMD than non-vegetarians. Additionally, a meta-analysis found that individuals following a plant-based diet exhibited lower BMD and higher rates of fractures in the femoral neck and lumbar spine than those following an omnivorous diet. Consequently, caution should be exercised when transitioning from an animal-based diet to a plant-based diet, particularly for individuals shifting towards a vegan diet.
Researchers at Fudan University in China analyzed data from 16,085 adult Americans who participated in the National Health and Nutrition Examination Survey [NHANES] between 2005 and 2018.
The researchers had access to scans that told how the bone mass of the study participants changed during the study. Thanks to interviews, the researchers also had an idea of the diet of the study participants and assigned the study participants 3 different scores on the basis of this.
One score was the plant-based diet index [PDI]. It is higher if someone eats more vegetable products and less animal products.
A second score was the healthy plant-based diet index [hPDI]. This is higher if a diet contains more healthy plant foods, such as vegetables, nuts, fruit and other whole products.
A third score was the unhealthy plant-based diet index [uPDI]. This is higher if there are more unhealthy vegetable products in the diet, such as foods with a lot of refined carbohydrates and sweetened juices.
A first group [AL] was allowed to eat as much and whenever they wanted. This was the control group. The mice in the other 5 groups received 70 percent of the food consumed by the mice in the AL group. The mice in these 5 groups were thus exposed to caloric restriction.
Results
The higher the study participants scored on the healthy plant-based diet index [hPDI] and the plant-based diet index [DPI], the greater their risk of osteopenia. Osteopenia is a precursor to osteoporosis.
High scores on the unhealthy plant-based diet index [uPDI] increased the risk of osteoporosis.
Conclusions
In conclusion, our findings provide evidence that adherence to a plant-based dietary pattern is associated with decreased BMD in a nationally representative population of US adults, highlighting the importance of a balanced diet for maintaining bone health, especially including foods rich in dietary calcium and protein such as vegetables, eggs, and meat. Meanwhile, a negative association was revealed between two plant-based dietary indexes (hPDI and PDI) and osteopenia, which was more significantly at the lumbar spine rather than the femoral neck. Among 15 individual food items, vegetables, refined grains, animal fat, eggs, and meat were the main protective contributors, whereas nuts were associated with increased odds of osteopenia. From a clinical perspective, dietary interventions rather than medications may be more effective in improving bone health and preventing fractures. Individuals following a plant-based diet should carefully plan their nutritional intake and monitor their bone health regularly. Moreover, further research is needed to explore the causality and generalizability of our findings, as well as to investigate the potential benefits and risks of specific types of plant-based diets in terms of their effects on bone health.
The Hidden Dangers of Plant-Based Diets Affecting Bone Health: A Cross-Sectional Study with U.S. National Health and Nutrition Examination Survey (NHANES) Data from 2005–2018
The plant-based dietary pattern has been recommended for its potential health and environmental benefits, but its association with bone loss needs to be further explored. This study aimed to investigate the association between three plant-based diet indexes and bone loss in 16,085 adults, using...
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