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Table 4 Risks of total and site-specific fractures by diet group in EPIC-Oxford, in participants with adequate levels of dietary calcium or protein

From: Vegetarian and vegan diets and risks of total and site-specific fractures: results from the prospective EPIC-Oxford study

Fracture site/diet group

Hazard ratios (95% confidence intervals)a

N cases

Dietary calcium ≥ 700 mg/day

N cases

Dietary protein ≥ 0.75 g per day/kg body weight

N cases

Dietary calcium ≥ 700 mg/day plus dietary protein ≥ 0.75 g per day/kg body weight

Total fractures

 Meat eaters

2077

Reference

2188

Reference

1925

Reference

 Fish eaters

377

0.92 (0.82, 1.03)

376

0.92 (0.82, 1.03)

332

0.90 (0.80, 1.02)

 Vegetarians

700

1.08 (0.98, 1.19)

648

1.07 (0.97, 1.18)

583

1.06 (0.96, 1.18)

 Vegans

49

1.50 (1.12, 1.99)

103

1.52 (1.24, 1.87)

44

1.45 (1.07, 1.97)

p-heterogeneityb

 

0.003

 

< 0.001

 

0.009

Arm fractures

 Meat eaters

300

Reference

304

Reference

273

Reference

 Fish eaters

54

0.96 (0.71, 1.30)

49

0.89 (0.65, 1.21)

46

0.91 (0.66, 1.26)

 Vegetarians

107

1.27 (0.99, 1.62)

98

1.24 (0.97, 1.59)

90

1.25 (0.96, 1.62)

 Vegans

8

1.76 (0.86, 3.61)

15

1.58 (0.92, 2.70)

7

1.61 (0.75, 3.46)

p-heterogeneityb

 

0.10

 

0.091

 

0.18

Wrist fractures

 Meat eaters

475

Reference

503

Reference

436

Reference

 Fish eaters

89

0.88 (0.70, 1.11)

96

0.93 (0.74, 1.16)

82

0.91 (0.71, 1.16)

 Vegetarians

146

0.96 (0.79, 1.18)

140

0.97 (0.79, 1.19)

126

0.99 (0.80, 1.23)

 Vegans

9

1.14 (0.58, 2.22)

21

1.35 (0.86, 2.12)

9

1.29 (0.66, 2.52)

p-heterogeneityb

 

0.71

 

0.47

 

0.74

Hip fractures

 Meat eaters

507

Reference

536

Reference

463

Reference

 Fish eaters

95

1.21 (0.96, 1.52)

97

1.19 (0.95, 1.49)

85

1.22 (0.96, 1.55)

 Vegetarians

136

1.25 (1.02, 1.54)

130

1.22 (0.99, 1.50)

115

1.25 (1.01, 1.56)

 Vegans

14

2.39 (1.39, 4.11)

31

2.71 (1.85, 3.95)

13

2.43 (1.38, 4.28)

p-heterogeneityb

 

0.003

 

< 0.001

 

0.004

Leg fractures

 Meat eaters

191

Reference

197

Reference

179

Reference

 Fish eaters

38

0.98 (0.68, 1.42)

38

1.04 (0.73, 1.50)

34

0.97 (0.66, 1.42)

 Vegetarians

61

1.00 (0.73, 1.37)

51

0.95 (0.68, 1.32)

46

0.87 (0.62, 1.24)

 Vegans

7

2.50 (1.15, 5.42)

16

2.90 (1.68, 4.99)

6

2.32 (1.00, 5.34)

p-heterogeneityb

 

0.13

 

0.001

 

0.17

Ankle fractures

 Meat eaters

277

Reference

296

Reference

263

Reference

 Fish eaters

49

0.84 (0.61, 1.15)

44

0.79 (0.57, 1.10)

40

0.77 (0.55, 1.09)

 Vegetarians

88

0.91 (0.70, 1.19)

79

0.97 (0.74, 1.27)

72

0.92 (0.69, 1.23)

 Vegans

3

0.73 (0.23, 2.31)

9

1.19 (0.60, 2.36)

3

0.85 (0.27, 2.69)

p-heterogeneityb

 

0.66

 

0.50

 

0.54

Other main site fracturesc

 Meat eaters

249

Reference

254

Reference

229

Reference

 Fish eaters

49

0.97 (0.70, 1.34)

47

0.95 (0.68, 1.31)

44

0.95 (0.68, 1.34)

 Vegetarians

84

0.97 (0.74, 1.27)

75

0.93 (0.70, 1.24)

70

0.93 (0.69, 1.25)

 Vegans

11

2.30 (1.23, 4.28)

18

1.82 (1.10, 3.01)

11

2.40 (1.28, 4.50)

p-heterogeneityb

 

0.06

 

0.08

 

0.03

  1. aAll analyses were stratified by sex, method of recruitment (general practice or postal), and region (7 categories), and adjusted for year of recruitment (per year from ≤ 1994 to ≥ 1999), ethnicity (white, other, unknown), Townsend deprivation index (quartiles, unknown), education level (no qualifications, basic secondary (e.g. O level), higher secondary (e.g. A level), degree, unknown), physical activity (inactive, low activity, moderately active, very active, unknown), smoking (never, former, light, heavy, unknown), alcohol consumption (< 1 g, 1–7 g, 8–15 g, 16+ g/day), dietary supplement use (no, yes, unknown), height (5 cm categories from < 155 to ≥ 185 cm, unknown), BMI (< 18.5, 18.5–19.9, 20–22.4, 22.5–24.9, 25–27.4, 27.5–29.9, 30–32.4, ≥ 32.5 kg/m2, unknown), and in women menopausal status (premenopausal, perimenopausal, postmenopausal, unknown), hormone replacement therapy use (never, ever, unknown), and parity (none, 1–2, ≥ 3, unknown)
  2. bRepresents heterogeneity in risk between diet groups based on Wald’s tests
  3. cDefined as fractures of the clavicle, rib, or vertebra