Osteoporosis and Fracture Risk in Ovarian Cancer: Beyond the Oncologic Burden

Background/Objectives: Osteoporosis is a prevalent condition characterized by reduced bone mass and microarchitectural deterioration, resulting in increased fracture risk. Ovarian cancer represents a paradigmatic model of cancer-related bone loss, owing to the combined effects of abrupt surgical menopause, chemotherapy, and tumor-driven pro-resorptive mechanisms. Methods: We conducted a narrative review of the literature on skeletal health in ovarian cancer. We synthesized current evidence on the pathogenesis, diagnostic strategies, and management of bone loss in women with ovarian cancer, with the aim of providing a disease-specific framework for clinical practice. Results: Available evidence highlights a multifactorial "triple hit" to bone health in ovarian cancer: accelerated estrogen deficiency following bilateral salpingo-oophorectomy, direct tumor-derived stimulation of osteoclast activity, and chemotherapy-induced skeletal toxicity. Despite the high incidence of bone loss and fractures, systematic bone health assessment is rarely integrated into oncological care. Dual-energy X-ray absorptiometry (DXA) remains the cornerstone diagnostic tool, complemented by vertebral morphometry and fracture risk algorithms. Antiresorptive therapies, particularly bisphosphonates and denosumab, together with calcium, vitamin D, exercise, and fall-prevention strategies, have demonstrated efficacy in reducing fracture risk, although disease-specific guidelines are still lacking. Conclusions: Fracture prevention in ovarian cancer survivors is often overlooked despite its significant impact on morbidity and quality of life. Integrating bone health assessment and early antiresorptive therapy into care pathways is warranted, and future studies should develop tailored guidelines to make bone protection a key element of survivorship care.