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Veganism, bone mineral density, and body composition: a study in Buddhist nuns



This cross-sectional study showed that, although vegans had lower dietary calcium and protein intakes than omnivores, veganism did not have adverse effect on bone mineral density and did not alter body composition.


Whether a lifelong vegetarian diet has any negative effect on bone health is a contentious issue. We undertook this study to examine the association between lifelong vegetarian diet and bone mineral density and body composition in a group of postmenopausal women.


One hundred and five Mahayana Buddhist nuns and 105 omnivorous women (average age = 62, range = 50–85) were randomly sampled from monasteries in Ho Chi Minh City and invited to participate in the study. By religious rule, the nuns do not eat meat or seafood (i.e., vegans). Bone mineral density (BMD) at the lumbar spine (LS), femoral neck (FN), and whole body (WB) was measured by DXA (Hologic QDR 4500). Lean mass, fat mass, and percent fat mass were also obtained from the DXA whole body scan. Dietary calcium and protein intakes were estimated from a validated food frequency questionnaire.


There was no significant difference between vegans and omnivores in LSBMD (0.74 ± 0.14 vs. 0.77 ± 0.14 g/cm2; mean ± SD; P = 0.18), FNBMD (0.62 ± 0.11 vs. 0.63 ± 0.11 g/cm2; P = 0.35), WBBMD (0.88 ± 0.11 vs. 0.90 ± 0.12 g/cm2; P = 0.31), lean mass (32 ± 5 vs. 33 ± 4 kg; P = 0.47), and fat mass (19 ± 5 vs. 19 ± 5 kg; P = 0.77) either before or after adjusting for age. The prevalence of osteoporosis (T scores ≤ −2.5) at the femoral neck in vegans and omnivores was 17.1% and 14.3% (P = 0.57), respectively. The median intake of dietary calcium was lower in vegans compared to omnivores (330 ± 205 vs. 682 ± 417 mg/day, P < 0.001); however, there was no significant correlation between dietary calcium and BMD. Further analysis suggested that whole body BMD, but not lumbar spine or femoral neck BMD, was positively correlated with the ratio of animal protein to vegetable protein.


These results suggest that, although vegans have much lower intakes of dietary calcium and protein than omnivores, veganism does not have adverse effect on bone mineral density and does not alter body composition.

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  1. Nguyen TV, Center JR, Eisman JA (2000) Osteoporosis in elderly men and women: effects of dietary calcium, physical activity, and body mass index. J Bone Miner Res 15:322–331

    Article  CAS  PubMed  Google Scholar 

  2. Limpaphayom KK, Taechakraichana N, Jaisamrarn U, Bunyavejchevin S, Chaikittisilpa S, Poshyachinda M, Taechamahachai C, Havanond P, Onthuam Y, Lumbiganon P, Kamolratanakul P (2001) Prevalence of osteopenia and osteoporosis in Thai women. Menopause 8:65–69

    Article  CAS  PubMed  Google Scholar 

  3. Ho SC, Lau EM, Woo J, Sham A, Chan KM, Lee S, Leung PC (1999) The prevalence of osteoporosis in the Hong Kong Chinese female population. Maturitas 32:171–178

    Article  CAS  PubMed  Google Scholar 

  4. Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA (1999) Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 353:878–882

    Article  CAS  PubMed  Google Scholar 

  5. Randell AG, Nguyen TV, Bhalerao N, Silverman SL, Sambrook PN, Eisman JA (2000) Deterioration in quality of life following hip fracture: a prospective study. Osteoporos Int 11:460–466

    Article  CAS  PubMed  Google Scholar 

  6. Randell A, Sambrook PN, Nguyen TV, Lapsley H, Jones G, Kelly PJ, Eisman JA (1995) Direct clinical and welfare costs of osteoporotic fractures in elderly men and women. Osteoporos Int 5:427–432

    Article  CAS  PubMed  Google Scholar 

  7. Ray NF, Chan JK, Thamer M, Melton LJ 3rd (1997) Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the National Osteoporosis Foundation. J Bone Miner Res 12:24–35

    Article  CAS  PubMed  Google Scholar 

  8. Nieves JW (2005) Osteoporosis: the role of micronutrients. Am J Clin Nutr 81:1232S–1239S

    CAS  PubMed  Google Scholar 

  9. Reid IR (1989) The role of dietary calcium in the pathogenesis and treatment of osteoporosis. N Z Med J 102:532–533

    CAS  PubMed  Google Scholar 

  10. Frassetto LA, Todd KM, Morris RC Jr, Sebastian A (2000) Worldwide incidence of hip fracture in elderly women: relation to consumption of animal and vegetable foods. J Gerontol A Biol Sci Med Sci 55:M585–592

    CAS  PubMed  Google Scholar 

  11. Sellmeyer DE, Stone KL, Sebastian A, Cummings SR (2001) A high ratio of dietary animal to vegetable protein increases the rate of bone loss and the risk of fracture in postmenopausal women. Study of Osteoporotic Fractures Research Group. Am J Clin Nutr 73:118–122

    CAS  Google Scholar 

  12. Fontana L, Shew JL, Holloszy JO, Villareal DT (2005) Low bone mass in subjects on a long-term raw vegetarian diet. Arch Intern Med 165:684–689

    Article  PubMed  Google Scholar 

  13. Wang YF, Chiu JS, Chuang MH, Chiu JE, Lin CL (2008) Bone mineral density of vegetarian and non-vegetarian adults in Taiwan. Asia Pac J Clin Nutr 17:101–106

    PubMed  Google Scholar 

  14. R Development Core Team (2008) R: A Language and Environment for Statistical Computing. URL:http://wwwR-projectorg Vienna, Austria

  15. New SA (2004) Do vegetarians have a normal bone mass? Osteoporos Int 15:679–688

    Article  PubMed  Google Scholar 

  16. Smith AM (2006) Veganism and osteoporosis: a review of the current literature. Int J Nurs Pract 12:302–306

    Article  PubMed  Google Scholar 

  17. Lau EM, Kwok T, Woo J, Ho SC (1998) Bone mineral density in Chinese elderly female vegetarians, vegans, lacto-vegetarians and omnivores. Eur J Clin Nutr 52:60–64

    Article  CAS  PubMed  Google Scholar 

  18. Appleby P, Roddam A, Allen N, Key T (2007) Comparative fracture risk in vegetarians and nonvegetarians in EPIC-Oxford. Eur J Clin Nutr 61:1400–1406

    Article  CAS  PubMed  Google Scholar 

  19. Leung SS, Lee RH, Sung RY, Luo HY, Kam CW, Yuen MP, Hjelm M, Lee SH (2001) Growth and nutrition of Chinese vegetarian children in Hong Kong. J Paediatr Child Health 37:247–253

    Article  CAS  PubMed  Google Scholar 

  20. Chiu JF, Lan SJ, Yang CY, Wang PW, Yao WJ, Su LH, Hsieh CC (1997) Long-term vegetarian diet and bone mineral density in postmenopausal Taiwanese women. Calcif Tissue Int 60:245–249

    Article  CAS  PubMed  Google Scholar 

  21. Outila TA, Karkkainen MU, Seppanen RH, Lamberg-Allardt CJ (2000) Dietary intake of vitamin D in premenopausal, healthy vegans was insufficient to maintain concentrations of serum 25-hydroxyvitamin D and intact parathyroid hormone within normal ranges during the winter in Finland. J Am Diet Assoc 100:434–441

    Article  CAS  PubMed  Google Scholar 

  22. Parsons TJ, van Dusseldorp M, van der Vliet M, van de Werken K, Schaafsma G, van Staveren WA (1997) Reduced bone mass in Dutch adolescents fed a macrobiotic diet in early life. J Bone Miner Res 12:1486–1494

    Article  CAS  PubMed  Google Scholar 

  23. Siani V, Mohamed EI, Maiolo C, Di Daniele N, Ratiu A, Leonardi A, De Lorenzo A (2003) Body composition analysis for healthy Italian vegetarians. Acta Diabetol 40(Suppl 1):S297–298

    Article  PubMed  Google Scholar 

  24. Key TJ, Appleby PN, Rosell MS (2006) Health effects of vegetarian and vegan diets. Proc Nutr Soc 65:35–41

    Article  CAS  PubMed  Google Scholar 

  25. Barzel US, Massey LK (1998) Excess dietary protein can adversely affect bone. J Nutr 128:1051–1053

    CAS  PubMed  Google Scholar 

  26. Hannan MT, Tucker KL, Dawson-Hughes B, Cupples LA, Felson DT, Kiel DP (2000) Effect of dietary protein on bone loss in elderly men and women: the Framingham Osteoporosis Study. J Bone Miner Res 15:2504–2512

    Article  CAS  PubMed  Google Scholar 

  27. Munger RG, Cerhan JR, Chiu BC (1999) Prospective study of dietary protein intake and risk of hip fracture in postmenopausal women. Am J Clin Nutr 69:147–152

    CAS  PubMed  Google Scholar 

  28. Feskanich D, Willett WC, Stampfer MJ, Colditz GA (1996) Protein consumption and bone fractures in women. Am J Epidemiol 143:472–479

    CAS  PubMed  Google Scholar 

  29. Fulgoni VL 3rd (2008) Current protein intake in America: analysis of the National Health and Nutrition Examination Survey, 2003–2004. Am J Clin Nutr 87:1554S–1557S

    CAS  PubMed  Google Scholar 

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We thank Prof. Lesley Campbell of the Garvan Institute of Medical Research for critical comments that led to an improvement of the manuscript. We thank all participants for their enthusiasm and cooperation in the study.

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Correspondence to T. V. Nguyen.

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Ho-Pham, L.T., Nguyen, P.L.T., Le, T.T.T. et al. Veganism, bone mineral density, and body composition: a study in Buddhist nuns. Osteoporos Int 20, 2087–2093 (2009).

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  • Body composition
  • Bone mineral density
  • Osteoporosis
  • Veganism