The Importance of Protecting Bone Health After Cancer Treatment or Risk-Reduction Surgery
At 32, I made one of the hardest medical decisions of my life: I chose to have a risk-reducing hysterectomy with removal of both my ovaries, which put me into premature menopause overnight.
I knew what ovarian cancer looked like up close. The youngest person in my family to be diagnosed with it was 31. I also knew how limited our screening tools are for ovarian cancer, and as a palliative care physician, I had cared for many women with end-stage disease. These experiences made my decision easier, but that doesn’t mean it was easy to live through.
Why Estrogen Matters for Your Bones
Estrogen is a woman's best friend. Most of us don’t realize that it protects our brain, heart, sexual health, and bones. Estrogen plays an important role in keeping our bones strong.
During menopause, estrogen levels naturally fall. Premature menopause — from chemotherapy or surgery — means losing that bone protection years earlier, which may increase the risk of developing weak bones and fractures later in life.
At the time of my surgery, I asked for a baseline DEXA scan, but my physician felt I didn’t need one because I would be using an estrogen patch. Two years later, my new physician suggested I get one, and it showed osteopenia. Osteopenia is the stage of bone thinning that comes before osteoporosis.
You can imagine how I felt about this finding. People living with the BRCA1 mutation — and others like it — may often face big, hard decisions to reduce our risk of one disease, only to be faced with an increased risk of another.
And that is also when we become resilient and resourceful. At least, that is how I see it.
A Simple Way to Protect Your Bones
In 2022, I started exercising regularly. I took strength training more seriously and lifted heavier weights. And I made it a goal to be more intentional about building and preserving the muscle I had.
Muscle is the longevity organ that protects our bones, metabolic health, and most importantly, our strength, balance, and independence as we age. So, I was super excited two years later when my DEXA scan results were normal for age bone density. And my scan results for this year were even better: normal for age bone density and I had increased my muscle mass, too.
Which Exercises Are Best for Your Bones?
The biggest bang for your buck is doing a combination of the above, and it keeps things fun. A practical plan might look like this: moderate to heavy strength or resistance training 2 to 3 times per week, some form of impact activity on most days, and balance exercises (like yoga) 2 to 3 days per week.
I walk my dog multiple times a day, strength train 4 to 5 times per week, and jump on my rebounder between meetings during the week. I also recently joined a rebounding class at my gym, which is bringing me a lot of joy!
Remember to start slow and build an active lifestyle that will be sustainable for the long term. If you already have osteoporosis or a history of fractures, I always recommend checking in with your doctor and a personal trainer to tailor your workout intensity to your specific needs, get accountability, and reduce the risk of injuries.
Other Strategies to Protect Your Bones
Beyond exercise, there are several other lifestyle and medical strategies to consider that can optimize and protect your bone health. These are particularly important if you are approaching natural menopause, are in premature menopause, or have gone through cancer treatment that has impacted your hormones.
Here are a few science-backed strategies to consider.
- Focus on protein and calcium-rich foods. Aim to get between 1.2 and 1.6 g per kilogram of your body weight of protein per day, and 1,000 to 1,200 milligrams (mg) per day of calcium, preferably from whole foods. Leafy greens, beans, lentils, fortified soy milk, and calcium-set tofu are all great options to support muscle and bone health.
- Check your vitamin D levels. Vitamin D helps your body use calcium. Knowing your numbers can help you determine if you need supplementation.
- Limit alcohol and avoid smoking.
- Maintain a healthy weight. Being overweight or underweight can be hard on our bones.
- Talk about hormone therapy (if appropriate). For women in premature menopause without contraindications, discussing hormone replacement therapy with your medical provider is an important strategy to reduce the downstream consequences of prolonged estrogen loss.
And if you already have osteoporosis, fractures, or significant osteopenia, just remember that you are not alone. My mom went into premature menopause in her mid-thirties after chemotherapy and she’s broken quite a few bones already. She is now in her late fifties and recently had a DEXA scan showing osteopenia. For most of her adult life, exercise and strength training has not been part of her regular routine. So, she is starting now — and that counts. Everyone’s situation is different, so talk to your medical provider about setting up a personalized approach.
A trainer recently said something to me that stuck: As we get older, we are not only lifting to gain muscle — we are lifting to maintain what we already have.
My recent DEXA results weren’t just luck. They are in line with what the research shows us — that consistent weight training, the food we put on our plate, and hormone replacement therapy all play a role in protecting and improving our bone health. Sometimes the test result isn’t our fate. It’s our invitation to get stronger.
Important: The views and opinions expressed in this article are those of the author and not Everyday Health.
- Mishra GD et al. Optimising Health After Early Menopause. The Lancet. March 9, 2024.
- Volpi E et al. Muscle Tissue Changes With Aging. Current Opinion in Clinical Nutrition & Metabolic Care. July 2004.
- Whitman PW et al. Does Exercising During Peri- or Early Post-Menopause Prevent Bone and Muscle Loss: A Systematic Review. Bone. September 16, 2025.
- Osteoporosis Prevention, Screening, and Diagnosis. Obstetrics & Gynecology. September 2021.
- Watson SL et al. High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial. Journal of Bone and Mineral Research. October 4, 2017.
- Ng C-A et al. Effects of Moderate‐ to High‐Impact Exercise Training on Bone Structure Across the Lifespan: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials. Journal of Bone and Mineral Research. November 1, 2023.
Grant Chu, MD, MS, MBA, FACP
Medical Reviewer
Grant Chu, MD, is an associate clinical professor at the David Geffen School of Medicine at UCLA. Dr. Chu is also associate director of inpatient East-West consult services at the ...
