Jennifer Heiner long worked for a New Jersey-based running company as retail director. In that position, she was responsible for operations at the three (soon to be four) commercial locations for the high-end performance apparel brand. Furthermore, she worked directly with the company’s founders on matters of business expansion and strategy. A few of her daily responsibilities include hiring, inventory control, and productivity optimization. Jennifer Heiner was also involved with race directing and coaching at the five annual races hosted by the company.

Currently, Jennifer Heiner works part time for a New York City based running company, assisting with customer service issues and in race-day production. Running races, and marathon season, is back in full swing for the summer. Unfortunately for Jennifer Heiner-Pisano, training has been rather stop and start over the past 5–6 years, as she has battled chronic pain due to several congenital issues, as well as a broken ankle (and two subsequent ankle surgeries).

There is a lot to be said about proper nutrition to aid in the recovery and healing process. and poor nutrition, or lack of enough energy in the form of food, can significantly impact an athlete, even a casual one. 

This recent article from Elizabeth Knight, Ph.D. sums up a lot of these issues well: 

https://medium.com/wise-well/recreational-athletes-dont-eat-enough-and-it-s-hurting-their-health-211f804435e0

Furthermore, additional studies have been done regarding nutrition and increase risk of fracture. 

Vegetarians at greater risk for hip fracture vs. meat eaters, study finds

Key takeaways:

Researchers partially attributed the greater fracture risk in vegetarians to lower BMIs.

Pescatarians and occasional meat eaters did not have an increased risk for hip fracture.

Vegetarians had a greater risk for hip fracture compared with regular meat eaters, although the absolute differences were small and “should be weighed against the potential health benefits of vegetarian diets,” according to researchers.

“Vegetarianism is becoming increasingly popular, but there is a concern around musculoskeletal health,” James Webster, PhD, a postgraduate researcher from the Nutritional Epidemiology Group at the University of Leeds, told Healio. “There are a few previous studies suggesting a higher risk of fractures in vegetarians than in meat eaters, but it is unclear if vegetarian men have a higher risk of hip fracture. Reasons underpinning risk differences are also unclear.”

Data derived from: Webster J, et al. BMC Med. 2023;doi:10.1186/s12916-023-02993-6

To better understand associations between dietary patterns and hip fracture risk, Webster and colleagues conducted a prospective cohort study using U.K. Biobank lifestyle and dietary data from 413,914 adults. Among those, 258,765 identified as meat eaters, 137,954 were occasional meat eaters, 9,557 were pescatarians and 7,638 were vegetarians.

Although vegetarians, pescatarians and occasional meat eaters all tended to be younger on average than meat eaters, “time to hip fracture and age at hip fracture were similar across diet groups,” the researchers wrote in BMC Medicine.

Over a median follow-up of 12.5 years, 3,503 hip fractures occurred.

After adjusting for confounders, the researchers found that vegetarians had a greater risk for hip fractures compared with meat eaters (HR = 1.5; 95% CI, 1.18-1.91), with an adjusted absolute risk difference of 3.2 additional fractures per 1,000 people over 10 years. This increased risk was not observed in occasional meat eaters or pescatarians.

Although there was limited evidence of an effect modification by sex, age and BMI, a mediation analysis suggested that BMI was attributed to 28% (95% CI, 1.1-69.8) of the risk difference between vegetarians and meat eaters, according to the researchers.

Webster noted that the benefits of a vegetarian diet include a lower risk for cancer and CVD and “may therefore outweigh any increases in hip fracture risk.”

However, he pointed out that vegetarians “were less likely to meet protein recommendations, had a lower BMI, lower vitamin D and [insulin-like growth factor 1] levels, and had lower dietary intake of several nutrients related to musculoskeletal health.”

“Therefore, vegetarians should maintain a healthy bodyweight and ensure adequate nutrient intakes, particularly for protein,” Webster said. “Additionally, since there was no difference in risk between occasional and regular meat eaters, reducing meat intake from the diet doesn’t seem to meaningfully affect hip fracture risk.”

The study had several limitations, according to the researchers. For example, they were not able to assess diet quality, which may have influenced hip fracture risk. The study also did examine fracture risk among vegans, who are less likely to meet recommended guidelines for protein and calcium and could be at higher risk for hip fracture, they noted.

Because the study was observational, Webster said the “findings cannot show causality.”

“Further studies are needed to confirm if vegetarian diets cause an increase in hip fracture risk and to identify why that might be,” he said. “This information will help to inform risk mitigation strategies.”

This study suggests that individuals following a long-term vegetarian diet have a small increase in risk for hip fractures compared with those who use dietary patterns that include meat. They suggest that this may be partially due to a less overweight BMI on average for individuals following a vegetarian diet, but I would not put much stock in this. It is more likely that individuals following a vegetarian diet tend to have less high-quality protein intake and therefore less muscle mass than individuals who include meat in their diet.

Justin Tondt, MD

Assistant professor, Penn State College of Medicine
Healio Primary Care Peer Perspective Board Member