Women who are vegetarian are more likely to experience hip fractures in later life than those who frequently eat meat, a UK study has found.

Researchers analysed health and diet records from more than 26,000 women and found that over a roughly 22-year period, vegetarians were a third more likely to break a hip than those who regularly ate meat.

The reasons for the greater risk are unclear but researchers suspect some vegetarians may not get sufficient nutrients for good bone and muscle health, leaving them prone to falls and fractures.

“The message for vegetarians is don’t give up your diet, because it is healthy for other things and environmentally friendly, but do take care to plan well and don’t miss out on nutrients that you exclude when you don’t eat meat or fish,” said Dr James Webster, a researcher at the University of Leeds.

Vegetarian diets are often considered healthier than meat-containing diets and they can reduce the risk of diabetes, obesity, heart disease and certain cancers. But the study published in BMC Medicine highlights the importance of a balanced diet whatever people eat.

“It’s likely that vegetarians, for one reason or another, and potentially because of lower intakes of important nutrients, have weaker bones and lower muscle mass and both of those things predispose people to hip fractures,” Webster said.

About 90% of hip fractures are linked to falls, which are more common in older people, who tend to be more frail and have weaker bones. But fractures can often drive further frailty, which increases the risk of more falls and worse frailty.

The researchers suspect vegetarians are more likely to be underweight than meat eaters, and that beyond having weaker bones and muscles may also have less fat, which can act as a cushion when people fall.

Given the findings, Webster said vegetarians may want to consider eating fortified cereals with added iron and B12 for bone health, and to ensure they are getting enough protein, through foods such as nuts, legumes and beans.

The researchers drew on data from the UK Women’s Cohort Study, which is tracking women over time to assess links between diet and health. Records for 26,318 women aged 35 to 69 revealed that 822, or 3%, had hip fractures in a roughly 22-year period. About 28% of the women were vegetarians and 1% were vegans.

The researchers compared the rate of hip fractures in vegetarians, pescatarians – those who eat fish but not meat – and occasional meat eaters with frequent meat easters. The frequent meat eaters ate meat at least five times a week.

Webster said more work was needed to see if vegetarian men had a similarly greater risk of hip fractures. Previous work suggests vegetarian men and women have poorer bone health on average when compared with meat-eaters “but risk of hip fracture in male vegetarians still remains unclear”, he said.

Eating less meat is one of the most important lifestyle changes people can make to reduce greenhouse gas emissions. Research from Leeds University last year found that non-vegetarian diets created 59% more emissions than vegetarian ones.

In work published in 2020, Dr Tammy Tong, a senior nutritional epidemiologist, and others at the University of Oxford, found that compared with meat eaters, vegetarians had a 25% greater risk of hip fractures, with the risk even high for vegans at 31%.

Vegetarians in the Leeds study had a lower body mass index (BMI) than regular-meat eaters, lower protein intake and lower vitamin D intake, “all of which are potential risk factors for hip fracture,” she said.

“Vegetarians should pay particular attention to maintaining a healthy body weight, and making sure that they have an adequate intake of protein and other nutrients important for bone health, including calcium and vitamin D.”