1. Long-term adherence to a plant-based diet was not associated with an increased risk of hip fractures in a cohort of US adult women.

2. Consumption of healthier plant-based options (whole fruits, vegetables) was associated with a 21% lower risk of fracture.

3. Consumption of more unhealthy plant-based options (fruit juices, processed foods, refined grains) was associated with a 28% higher risk of fracture.

Evidence Rating Level: 1 (Excellent)

As the aging process ensues, fractures become a public health concern as older adults have decreasing bone mass, especially postmenopausal women. Despite a large push for plant-based diets for health-related reasons, there has been concern in the past that adherence to these diets may result in poor effects on bone health. Even less characterized, is the relationship between the quality of plant based diets to bone health. In this prospective cohort study, researchers included data from 70,285 postmenopausal women that were included in the US Nurses’ Health Study from 1984 to 2014. Researchers scored the quality of diets via the healthful Plant-Based Diet Index (hPDI) and unhealth Plant-Based Index (uPDI), validated tools that effectively grade diets according to the proportion of healthy foods (ex., whole fruits, vegetables) compared to less healthy foods (sweets, fruit juices, processed foods), respectively.  A total of 7285 individuals participated in the study, with 2038 cases of hip fractures amongst them during the follow-up period of 30 years. The mean (SD) age of participants was 54.92 (4.48) years at baseline, with everyone being white. The mean (SD) hPDI was 54.33 (7.33) points while the mean uPDI was 54.38 (7.70) points. Energy consumption was analyzed, and the mean (SD) was 1743.64 (521.07) kcal while the mean BMI was 25.69 (4.85), which is classified as overweight. Individuals with a higher hPDI had healthier diets that included more calcium along with plant-based foods and were more physically active compared to participants with a lower hPDI. Individuals with a higher uPDI had lower levels of physical activity and lower calcium intake along with less healthy plant food consumption. The adjusted hazard ratio (HR) was 0.97 (95% CI, 0.83-1.14) for the highest quintile (Q5) vs the lowest quintile (Q1) for the hPDI and 1.2 (95% CI, 0.87-1.20) for the uPDI. In more recent tests, there was a 21% decreased risk of hip fracture associated with the hPDI (HR, 0.79 [95% CI, 0.68-0.92]; P=.02 for trend) while there was a 28% increased risk associated with the uPDI (HR, 1.28 [95% CI, 1.09-1.51]; P=.008 for trend). Overall, study findings indicated that longterm adherence to plant-based diets were not associated with hip fracture risk. Furthermore, greater consumption of healthier plant-based foods compared to less healthy options provided additional protection against hip fractures.

Click to read the study in JAMA Network Open

Image: PD

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