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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