Summary: What This Article Covers
A 2025 meta-analysis raised concerns that plant-based diets increase the risk of osteoporosis. This article explains what that research actually found, why the two studies driving that result have significant limitations, and what three decades of data from Harvard’s Nurses’ Health Study show instead.
Key findings covered here:
- Following a plant-based diet for many years did not lead to an increase or decrease in hip fracture risk in the Nurses’ Health Study.
- A healthy plant-based diet was linked to 21% lower fracture risk; an unhealthy one to 28% higher risk. Diet quality is what matters, not diet style.
- Resistance training eliminates the bone deficit seen in vegans who don’t lift. Aerobic exercise alone does not.
- The two Taiwan studies that drove the 2025 meta-analysis collected no data on resistance exercise, supplement use, or nutritional adequacy of the diet.
- “Beans and Greens” is where to get your calcium.
- For optimal bone health, pay special attention to vitamin B12, vitamin C, vitamin D3, vitamin K2, and magnesium intake, and ensure adequate protein and long-chain omega-3 fats.
The bottom line: A well-planned plant-based diet combined with regular resistance training is fully compatible with strong bones after menopause. Like Jack LaLanne said, “Exercise is king and nutrition is queen: together, you have a kingdom.“
Introduction
You may have heard recently that following a plant-based diet increases your risk of osteoporosis. A high-profile meta-analysis published in Clinical Nutrition in 2025 found an association between plant-based diets and an elevated risk of osteoporosis.
If you just look at the headline, you might draw the obvious conclusion, but you would have missed the details and the rest of the story. After all, it isn’t just people following plant-based diets who have osteoporosis now, is it? There are specific, actionable steps you can take to protect your bones well into your later years. Let’s walk through what the research actually shows.
The Study That Got Everyone’s Attention
Sirui Zheng and colleagues at the West China School of Public Health at Sichuan University published a systematic review and meta-analysis in Clinical Nutrition in June 2025, pulling together 20 observational studies involving 243,366 participants. They found that plant-based diets were associated with higher risk of osteoporosis at the lumbar spine compared to omnivorous diets. Vegans and people who had followed a plant-based diet for 10 years or more showed the most pronounced association. The meta-analysis was well done and methodologically sound.
But a meta-analysis is only as good as the studies that feed into it. I’ve seen this over the years, time and time again. Authors of meta-analyses have a way of excluding inconvenient data or minimizing good data with a lot of bad data to make a point, using the “bully pulpit” of nutrition science (the meta-analysis) to push their own agenda.
I’m not saying that any malfeasance was at play, or that the authors had bad intentions in this particular case. But it’s a far cry from saying that people following a whole foods plant-based diet have a higher risk of osteoporosis. That’s not what’s going on here. There were two studies that drove most of the results. Let’s look at those two in particular.
Are Taiwanese vegans actually healthy?
The two most influential studies in the Zheng meta-analysis were both conducted in Taiwan. About 215,000 of the 240,000 participants were in these two studies. Even though there were 20 observational studies, the analysis was really heavily influenced by these two.
The first, by Tzu-Liang Hsu and colleagues at the Taiwan Biobank, published in Archives of Osteoporosis in 2023, analyzed 20,110 adults (12,910 women and 7,200 men, mean age 55.5 years). Current vegetarians showed lower BMD Z-scores at the spine, left hip, and right hip compared to non-vegetarians. That’s a significant finding.
The second, by Ping-Chen Chung and Ta-Chien Chan, published in BMC Public Health in 2022, drew on a health check-up database with nearly 195,000 participants and found that consuming a vegetarian diet increased the risk of low bone mineral density.
But neither of these studies collected any data on resistance exercise. Nor did the studies ask whether the participants were lifting weights, doing any form of weight-bearing resistance training, or exercising at all, for that matter.
Neither study recorded whether the participants were taking supplements, such as vitamin D, vitamin K2, B12, or other beneficial supplements. Both studies used a very simplistic question to assess the diet. In one of them, just a single question was used to determine their dietary preferences. Some of the smaller studies did use semi-quantitative food frequency questionnaires, which are typical in nutritional studies. But these two studies did nothing of the sort. So we really don’t know what kind of vegetarian diet these people in Taiwan really followed.
These unknown details could make a big difference. As the Zheng team themselves acknowledged in their discussion, clinicians should “emphasize nutrient adequacy, such as intakes of calcium, vitamin D, and vitamin B12, through fortified foods or supplements, alongside education on balanced plant-based eating.” The problem the Taiwan data captured wasn’t plant-based eating. Vegetarians and vegans in Taiwan might be following the diet for cultural reasons and not really paying much attention to their health overall. This is a very different sort of diet from someone intentionally following a whole-food plant-based diet for its health benefits.
Findings from a 30-Year Harvard Study of Healthy vs. Unhealthy Plant-Based Diet Index
The most definitive study on plant-based eating and fracture risk in postmenopausal women was published in JAMA Network Open in February 2024 by Mercedes Sotos-Prieto at Harvard’s T.H. Chan School of Public Health, along with Walter Willett, Frank Hu, and Shilpa Bhupathiraju at Brigham and Women’s Hospital.
They followed 70,285 postmenopausal women in the Nurses’ Health Study from 1984 through 2014, a 30-year window in which 2,038 hip fractures were recorded. Their conclusion: long-term adherence to a plant-based diet was not associated with hip fracture risk. Not higher. Not lower. It just wasn’t a factor.
But when they looked at the quality of plant-based eating, a clear pattern emerged. Women in the highest quintile of a healthy plant-based diet index, defined by high intake of whole grains, vegetables, fruits, legumes, nuts, and vegetable oils, had a 21% lower risk of hip fracture compared to women in the lowest quintile. Women in the highest quintile of an unhealthy plant-based diet index, dominated by refined grains, sweetened beverages, fruit juices, potatoes, and sweets, had a 28% higher risk.
In this population of American women, it’s unlikely that any of them were really gung-ho about whole-food, plant-based diets. They just tended to eat more whole grains and vegetables, or more refined grains and sweetened beverages and sweets.
The difference in their diets wasn’t huge, but the findings were important. Eating whole plant foods does protect you from osteoporosis, and eating white bread, chips and soda is bad for you and causes bone loss.
The Exercise Variable Nobody’s Talking About
Here’s another factor that barely makes the headlines when osteoporosis and vegan diets are discussed. But research suggests that it might be the most important variable of all. And no one’s talking about it when putting down plant-based diets as being inferior.
Robert Wakolbinger-Habel and Christian Muschitz at the Medical University of Vienna published a study in the Journal of Clinical Endocrinology and Metabolism in 2022 that used high-resolution peripheral quantitative computed tomography (HR-pQCT), an advanced imaging method that reveals fine details of trabecular and cortical bone structure well beyond what a standard DEXA scan captures. They compared 43 vegans and 45 omnivores, all ages 30-50, all of healthy weight.
The vegans who did no resistance training showed significant deficits in bone microarchitecture across 7 of 14 measures compared to omnivores. That confirms what the Taiwan data suggested.
But vegans who engaged in resistance training at least once a week, using free weights, machines, or body-weight resistance exercises, showed no significant differences in bone microarchitecture compared to omnivores who also engaged in resistance training. The bone deficit between the two groups simply disappeared.
The researchers also confirmed again that aerobic exercise alone, whether walking, cycling, or swimming, didn’t produce the same results. It was resistance training that made the difference.
Wakolbinger-Habel was direct: “In addition to a well-planned diet, progressive resistance training on a regular basis should be part of the vegan lifestyle.” I would add that resistance training should be part of everyone’s lifestyle. And vegans are not an exception to that.
A Hallelujah Diet Study Reached the Same Conclusion Sixteen Years Earlier
I want to share something from our own research that reinforces exactly what the Vienna team found.
Beginning in 2006, the Hallelujah Acres Foundation ran a three-year bone health study with women attending our Health Ministers Reunions. We enrolled 68 women and used ultrasound to measure bone strength in the heel at multiple time points. Of those 68 women, 29 had three or more measurements, giving us enough data to track trends over time.
Before the study started, we already expected the Hallelujah Diet to protect bone health. We gave participants a clear protocol: take B-Flax-D daily, spend more time in the sun, eat at least one additional serving of dark leafy greens per day, exercise daily, eat legumes at least three times a week, and drink remineralized water. The diet aspect was well-covered.
What we found surprised us. Among the 29 women with multiple measurements, 12 lost relative bone strength, 10 remained the same, and 7 actually increased bone strength. Simply following the Hallelujah Diet did not automatically guarantee strong bones over time. We then analyzed every dietary and lifestyle variable we had collected: body weight changes, vitamin D levels (tested in 2008 and 2009), blood pressure, pulse rate, exercise frequency and duration, and detailed food intake measures for vegetable juice, BarleyMax, salads, fruits, nuts, seeds, fiber, and flax oil. None of them correlated with bone outcomes. None.
The only factor that mattered was the type of exercise the women were doing.
Of the 21 women who reported any resistance training during the study, only 5 lost bone. Of the 8 women who reported only aerobic exercise, 6 lost bone. The relative risk of bone loss for the resistance exercise group was 0.32, statistically significant at p = 0.028 by Fisher’s exact test. When we narrowed the analysis to the 13 women who had been resistance training for more than one year, only 2 of them lost bone. Among the 16 women doing mostly aerobic exercise, 9 lost bone.
All the questions about whether the Hallelujah Diet has enough calcium, enough protein, enough greens, or enough of some particular nutrient turned out to be secondary for bone health.
What your bones need is exercise, and specifically the right kind of exercise.
The same conclusion the Medical University of Vienna published in 2022 is what we saw in our own participants sixteen years earlier. I had read about that in the literature, and I saw how true it was, with the woman right in front of my eyes.
The Hormone Factor: Why the First Five Years After Menopause Are Critical
For postmenopausal women, no discussion of osteoporosis is complete without addressing estrogen. Bone loss accelerates sharply in the first five to seven years after menopause, driven primarily by the drop in estrogen. Estrogen directly suppresses osteoclasts, the cells responsible for breaking down bone tissue. When estrogen declines, bone resorption starts to outpace bone formation, and density falls.
A great diet can slow this process, but it cannot replace hormonal support. One of the mechanisms worth understanding here is your estrobolome: the subset of gut bacteria that metabolize and recycle estrogen through a specific enzymatic pathway. A diverse, fiber-rich gut microbiome supports that recycling process. A whole-food plant-based diet is one of the best ways to maintain that diversity. (We’ve covered the estrobolome in detail in our article Harness Your Gut’s Estrobolome for Better Menopause Outcomes.
The practical takeaway: if you’re in the first five to ten years post-menopause, your bone loss trajectory is being shaped significantly by hormonal factors. What you eat can make a real difference, but only if you’re also paying close attention to the nutritional factors that specifically support bone in the absence of robust estrogen.
Here too, in these years, resistance exercise is especially important to save your bones.
The Alkaline Advantage, and a Myth Worth Retiring
For years, some in the plant-based health community argued that animal-protein diets caused osteoporosis by triggering an acid load that forced the body to draw calcium from bones to restore blood pH. That calcium-leaching mechanism has since been shown to be inaccurate. Animal protein does produce more metabolic acid, but the kidneys handle that load through multiple buffering systems, including increased calcium absorption, and not primarily through calcium extraction from bone.
What has held up in the research is different. Plant proteins arrive in your body bundled with minerals, organic acids from fruits and vegetables, and other compounds that leave a net alkaline metabolic residue. This metabolic advantage is more clearly connected to muscle preservation than to bone calcium conservation. And that connection is important.
Sarcopenia, the age-related loss of muscle mass that accelerates in postmenopausal women, and osteoporosis are closely linked conditions. Loss of muscle mass reduces the mechanical loading on bones, which is one of the primary signals that tells bone tissue to maintain its density. A net alkaline dietary pattern that preserves muscle mass is, indirectly, protecting bone as well. This is one more reason why the combination of a whole-food plant-based diet and resistance exercise is more powerful than either one alone.
Inflammation, Bone Remodeling, and Omega-3 Fats
Bone is not static tissue. It is continuously being broken down by cells called osteoclasts and rebuilt by cells called osteoblasts. Osteoporosis develops when that balance tips persistently toward resorption. One of the key regulators of this balance is the inflammatory environment surrounding bone cells. Pro-inflammatory cytokines, particularly IL-6 and TNF-alpha, drive osteoclast formation and activity. Chronic inflammation, which rises after menopause, accelerates that resorption process.
Omega-3 fatty acids, specifically EPA and DHA, work on this pathway directly. They reduce the production of IL-6 and TNF-alpha and shift the ratio of two proteins, OPG and RANKL, in favor of bone preservation. RANKL stimulates osteoclast activity; OPG blocks it. Arachidonic acid, the dominant omega-6 fatty acid in a Western diet, does the opposite: it suppresses OPG production and drives RANKL expression, tilting the balance toward bone loss. A high intake of DPA and DHA tilts the balance towards healthy bone remodeling.
A 2024 cross-sectional analysis of 8,889 U.S. adults in the NHANES database, published in Frontiers in Nutrition, found that participants in the highest quartile of dietary omega-3 intake had a 29% lower risk of osteoporosis compared to those in the lowest quartile. The protective effect was stronger in women than men. A systematic review of randomized trials found that four of ten studies showed significant favorable effects of omega-3s on bone density or bone turnover markers, with the most consistent benefit when omega-3s were combined with adequate calcium.
Now, keep in mind that omega-3s are a great supporting factor for bone health. Resistance exercise is the primary driver and has the largest, most consistent beneficial effect. But for postmenopausal women who are supplementing strategically, fish oil is a reasonable addition to the protocol, given its benefits for cardiovascular and brain health.
Here is a Practical Roadmap for Postmenopausal Women
The research gives postmenopausal women on a plant-based diet a clear set of priorities.
Make resistance training non-negotiable.
This is the single most important variable identified by the research. Aim for at least two to three sessions per week using free weights, resistance machines, or resistance bands that genuinely challenge your muscles. Build strength. Aerobic exercise is valuable for cardiovascular health and should not be skipped, but it won’t close the bone gap that a plant-based diet can create without mechanical loading. (The aerobic-only groups in the Vienna study performed no better on bone structure than sedentary participants.)
Prioritize calcium-rich plant foods.
You don’t need dairy to meet your calcium needs. Leafy greens, legumes (“beans and greens” is a simple way to remember this list), and fortified plant milks provide substantial calcium with good bioavailability, especially when vitamin D levels are adequate. See our full guide to plant-based calcium sources for amounts and details. A short list to start with:
- Collard greens and bok choy
- Kale and broccoli
- White beans, chickpeas, and edamame
- Almonds and almond butterCalcium-set tofu
- Fortified plant milk (look for brands with calcium carbonate or tricalcium phosphate)
Supplement with D3 and K2 together.
Vitamin D3 drives calcium absorption in the gut. Vitamin K2 directs that calcium toward bone rather than toward soft tissue. They don’t work as well on their own as they do together. Our Hallelujah Diet Vitamin D3 with K2 combines both. Aim for serum vitamin D levels of 50-80 ng/mL, which usually requires supplementation, especially in northern climates or for women who spend limited time outdoors. We’ve covered the D3 and K2 relationship in more depth in our article Should I Take Vitamin K with My Vitamin D Supplement?.
Add ground flaxseed for lignans.
Flaxseed is the richest known dietary source of lignans, plant compounds that gut bacteria convert into weak phytoestrogens called enterolignans. These bind lightly to estrogen receptors and can help buffer some of the hormonal effects of menopause, including those affecting bone remodeling. Our B-Flax-D provides stabilized ground flax combined with added vitamins and minerals. The flax fiber also feeds the gut microbiome, which drives estrogen recycling through the estrobolome.
Eat enough protein.
The bone matrix is primarily collagen. Adequate protein intake, roughly 1.0 to 1.2 grams per kilogram of body weight daily, supports both bone matrix integrity and muscle mass. Legumes, lentils, tofu, tempeh, edamame, hemp seeds, and pea protein are all strong sources. Distribute protein across your meals rather than concentrating it in a single sitting.
Protect your vitamin C intake.
Vitamin C is a critical cofactor for collagen synthesis, which is the structural scaffolding of bone. Higher vitamin C intake has been consistently associated with reduced fracture risk in multiple large studies. We’ve covered the evidence in our article The Missing Piece: Why You Need Vitamin C for Strong Bones.
Add fish oil for the omega-3 benefit.
As discussed above, EPA and DHA reduce the inflammatory cytokines that drive bone resorption and support the OPG/RANKL balance in favor of bone building. Plant-based eaters typically get ALA from flaxseed and walnuts, but conversion to the more active EPA and DHA is limited. Our Hallelujah Diet Omega-3 Fish Oil provides preformed EPA and DHA, adding a targeted anti-inflammatory benefit that the diet alone may not fully cover.
Don’t overlook magnesium.
Magnesium is a structural component of bone and a cofactor in vitamin D activation. A 2021 review of 28 studies found that lower magnesium blood levels were linked to the presence of osteoporosis and that hypomagnesia was present in 30-40% of postmenopausal women. Fortunately, a whole-food plant-based diet is naturally rich in magnesium: dark leafy greens, legumes, nuts, seeds, and whole grains all contribute meaningfully. This is one area where the plant-based diet actually has a structural advantage over a meat-heavy Western diet.
Monitor B12 levels and understand why B12 is especially important for bones.
Most people know B12 deficiency causes neurological problems. Fewer know it raises homocysteine levels, and that high homocysteine is an independent risk factor for fracture, separate from bone density. A prospective study of 2,406 adults found that those with homocysteine in the highest quartile had nearly double the fracture risk of those in the lowest quartile, even after adjusting for BMD. The Framingham Osteoporosis Study found a 4-fold increased hip fracture risk in men and almost a 2-fold increase in women with the highest versus lowest homocysteine levels. For plant-based eaters, B12 supplementation isn’t optional. A simple blood test for B12, homocysteine, and vitamin D tells you where you stand.
A Hallelujah Diet Perspective
The research we’ve walked through here is consistent with what we’ve long believed: a well-planned, whole-food plant-based diet, combined with intentional resistance exercise and targeted supplementation, is fully compatible with strong bones well into postmenopause. There are specific things you need to do. But the path is clear.
At Hallelujah Diet, our purpose is to equip men and women with the health and vitality to fulfill the calling God has placed on their lives. Bone loss that leads to fractures and limited mobility is not part of that plan. Whether you’re raising a family, serving your community, building a business, or simply wanting to remain active and independent for decades to come, your bones are part of your foundation. God designed the human body to be resilient and self-healing when it’s given what it needs. We’re here to help you with information and guidance along the way.
References
- Zheng S, et al. “Plant-based diet and risk of osteoporosis: A systematic review and meta-analysis.” Clinical Nutrition. 2025;50:253-262. https://pubmed.ncbi.nlm.nih.gov/40494032/
- Hsu TZ, et al. “Spine, hip, and femoral neck bone mineral density in relation to vegetarian type and status among Taiwanese adults.” Archives of Osteoporosis. 2023;18:134. https://doi.org/10.1007/s11657-023-01320-z
- Chung PC, Chan TC. “Environmental and personal factors for osteoporosis or osteopenia from a large health check-up database: a retrospective cohort study in Taiwan.” BMC Public Health. 2022;22:1531. https://doi.org/10.1186/s12889-022-13938-8
- Sotos-Prieto M, et al. “Plant-Based Diets and Risk of Hip Fracture in Postmenopausal Women.” JAMA Network Open. 2024;7(2):e241107. https://pubmed.ncbi.nlm.nih.gov/38421643/
- Wakolbinger-Habel R, et al. “Self-reported Resistance Training Is Associated With Better HR-pQCT-derived Bone Microarchitecture in Vegan People.” Journal of Clinical Endocrinology and Metabolism. 2022;107(10):2900-2911. https://pubmed.ncbi.nlm.nih.gov/35924941/
- Cao Z, et al. “The association between dietary omega-3 intake and osteoporosis: a NHANES cross-sectional study.” Frontiers in Nutrition. 2024;11:1467559. https://doi.org/10.3389/fnut.2024.1467559
- van Meurs JB, et al. “Homocysteine levels and the risk of osteoporotic fracture.” New England Journal of Medicine. 2004;350(20):2033-41. https://www.nejm.org/doi/full/10.1056/NEJMoa032546
- Ali Z, et al. “Unraveling the Omega-3 Puzzle: Navigating Challenges and Innovations for Bone Health and Healthy Aging.” Marine Drugs. 2024;22(10):446. https://doi.org/10.3390/md22100446
