Part 3: Bone, sleep & key nutrients in menopause
Perimenopause and menopause can bring hot flushes, mood changes, and sleep disruption but theres also a quieter side of this transition: bone density changes, shifts in muscle mass, and the way sleep and metabolism start to influence each other.
At Deep Water Medicine, we approach menopause support holistically: symptom relief matters, and so does protecting long-term health.
This post summarises key points from the 2024 review The Importance of Nutrition in Menopause and Perimenopause (Erdlyi et al., Nutrients) and translates them into clear, doable steps.
Bone health: why risk rises around menopause
The review explains that osteoporosis is a common concern during menopause. Bone loss tends to accelerate beginning 13 years before menopause and can continue for 5-10 years, with an average annual loss around 2%, leading to a meaningful drop in bone mineral density over time.
Bone health is influenced by:
- estrogen decline
- vitamin D status
- calcium intake and absorption
- body composition (including low muscle mass)
- exercise habits
- smoking and alcohol
- medical conditions affecting absorption (e.g., gut disorders)
Osteoporosis vs fracture risk
Low bone density is one part of the picture. Fracture risk also depends on factors like previous fractures, family history, frailty, dizziness, and other health conditions.
The menopause body composition shift: muscle matters
The review notes that during this transition:
- visceral fat tends to increase
- fat-free mass and skeletal muscle mass can decrease
This matters because muscle supports:
- glucose control
- metabolic rate
- balance and fall prevention
- bone strength (through loading)
Thats why a menopause-friendly plan isnt just about weight its about body composition.
Key nutrients highlighted in the review
1) Protein (for muscle + healthy ageing)
The review suggests::
- 0.8 g/kg/day as a baseline in a balanced diet
- 11.2 g/kg/day during weight loss and with regular exercise
A practical target for many women is to include a protein source at each meal (and often at breakfast, which often doesn’t include as much protein). How much protein do you think you have in a day?
2) Vitamin D (critical for bone health)
Vitamin D supports calcium absorption and bone metabolism.
The review notes that when UV-B exposure is insufficient (season, indoor lifestyle, sun protection), dietary intake and/or supplementation becomes important. It also highlights that osteoporosis treatments work better when vitamin D status is adequate.
Practical note: Supplement needs are individual. Your GP can check vitamin D levels and advise on dosing, and, different practitioners can suggest different things. Normal testing recommending a blood reading over 50 (it used to be 60), and optimal over 80.
3) Calcium (food-first when possible)
The review emphasises that calcium needs can often be met through diet, and routine supplementation isnt always recommended for everyone (it can depend on cardiovascular risk and individual factors).
Food sources include:
- dairy (if tolerated)
- calcium-fortified foods
- mineral waters with higher calcium content
- soft-boned fish (e.g., sardines)
- some nuts/seeds and leafy greens (absorption varies)
4) Vitamin C (collagen + bone formation)
Vitamin C supports collagen formation, which is relevant for bone structure.
Food sources:
- capsicum
- citrus
- berries
- sauerkraut
- fresh vegetables and fruit
5) B vitamins (nervous system + healthy ageing)
The review discusses B vitamins in relation to carbohydrate metabolism and nervous system function, and notes links between adequate B vitamin intake, homocysteine levels, and vascular/bone health.
Be mindful there have been multiple cases of Vit. B6 poisoning due to supplements as people are taking too much. This can happen when some is included in a B vitamin complex, multi-vitamin, and magnesium supplement for example. Make sure you know what you are taking or contact a professional for advice.
Sleep: common in menopause, and it affects metabolism
Sleep difficulties are more likely during menopause, with self-reported rates commonly around 4056% (and a pooled prevalence around 51.6% in one meta-analysis cited in the review).
Poor sleep can affect:
- appetite regulation
- glucose metabolism
- weight gain risk
- cardiovascular risk
Nutrition that may support sleep (simple, not fussy)
The review discusses:
- regular meal timing (supports circadian rhythm)
- avoiding large fluid intake right before bed
- nutrients involved in melatonin synthesis (e.g., folate, B6, B12, magnesium, zinc)
- tryptophan-containing foods (a melatonin precursor)
Practical ideas:
- Eat dinner at least 2 hours before bed when possible
- Keep caffeine earlier in the day if sleep is fragile
- Consider a balanced evening meal (not just carbs, not just salad)
A simple bone + sleep foundation you can actually stick to
- Strength train 2x/week (or start with guided bodyweight/resistance)
- Eat protein at every meal
- Include calcium-rich foods daily (food-first)
- Check vitamin D if youre unsure (especially if indoors a lot)
- Keep a consistent meal rhythm (especially dinner timing)
- Walk daily if possible (bone + mood + sleep)
- Avoid smoking and keep alcohol moderate (bone and sleep both benefit)
Want support?
If youre navigating perimenopause or menopause and want support, we can help.
Appointments are available Lez & Lorielle online at https://deepwatermedicine.com.au or call 08 8323 9844.
Important note: This is general education and not individual medical advice. If you have new or concerning symptoms, please speak with your GP and/or a qualified practitioner.
Erdélyi, A.; Pálfi, E.; Tűű, L.; Nas, K.; Szűcs, Z.; Török, M.; Jakab, A.; Várbíró, S. The Importance of Nutrition in Menopause and Perimenopause—A Review. Nutrients 2024, 16, 27. https://doi.org/10.3390/nu16010027