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Sticking to a vegetarian diet was linked to higher risk of hip fracture among women, a cohort study indicated.

Vegetarian women ages 35 to 69 saw a 33% higher risk for hip fracture than those who regularly ate meat (HR 1.33, 95% CI 1.03-1.71) during more than 2 decades of follow-up, James Webster, PhD, of the University of Leeds in the U.K., and colleagues reported in .

This hip fracture risk wasn't seen among pescatarians (HR 0.97, 95% CI 0.75-1.26) nor women who only occasionally ate meat (HR 1.00, 95% CI 0.85-1.18).

Lower intake of protein, calcium, and other micronutrients linked with bone and muscle health is often concerning with vegetarian diets, Webster said in a statement. "This makes it especially important for further research to better understand factors driving the increased risk in vegetarians, whether it be particular nutrient deficiencies or weight management, so that we can help people to make healthy choices."

He added that this study wasn't warning people to totally steer clear of vegetarian diets, but to weigh the pros and cons of any diet with personal circumstances. In addition, women should be aware of exactly which nutrients they may need to supplement for proper nutrition.

"Vegetarian diets can vary widely from person to person and can be healthy or unhealthy, just like diets that include animal products," he advised.

In the 822 hip fracture cases seen among 26,318 women between the ages of 35 to 69 in the U.K. Women's Cohort Study, BMI didn't appear to play any meditating factor in this association with diet type. That being said, women with a BMI under 23.5 had a 46% higher risk for fracture, regardless of diet type.

These models were adjusted for a slew of potential confounders, including ethnicity, sociodemographics, marital status, menopausal status, number of children, history of cardiovascular disease, cancer, diabetes, and lifestyle factors like exercise, smoking status, and nutritional supplement use.

"Hip fracture is a global health issue with high economic costs that causes loss of independence, reduces quality of life, and increases risk of other health issues," said co-study author Janet Cade, PhD, also of the University of Leeds, in a statement.

"Plant-based diets have been linked with poor bone health, but there has been a lack of evidence on the links to hip fracture risk," she said. "This study is an important step in understanding the potential risk plant-based diets could present over the long-term and what can be done to mitigate those risks."

The researchers found some key nutritional differences between women with different diets. Not surprisingly, women who regularly ate meat had the highest intake of protein, vitamin D, and vitamin B12. On the other hand, the vegetarian group had the lowest intake of all three.

Total calcium intake was similar between all diets, though.

In general, women in the study who ate a pescatarian or vegetarian diet tended to be younger, have higher levels of education, were more likely to have professional or managerial jobs than manual jobs, and were less likely to be married or have any children. Women adhering to these diets also tended to weigh less than those who regularly ate meat.

Regular meat eaters also had some of the highest levels of cancer, diabetes, and cardiovascular disease at baseline.

Diets were confirmed using a 217-item food frequency questionnaire. Women deemed "regular" meat-eaters were those who consumed five or more servings per week, while "occasionally" meat-eaters ate less than five servings. Pescatarians ate fish but not meat, and vegetarians abstained from both fish and meat.

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