In states of estrogen deficiency bone loss is evident. We investigated two interventions that cause estrogen deprivation in the setting of breast cancer prevention:​ 1) prophylactic salpingooophorectomy, being the surgical removal of the ovaries and fallopian tubes, and 2) exemestane therapy, which prevents estrogen synthesis in the body. In the literature, bone density loss following these interventions has been studied;​ however, bone density does not encompass all aspects of bone strength. Our aim was to investigate bone loss after these interventions using a novel measure which assesses bone architecture termed trabecular bone score (TBS). We hypothesized that due to estrogen depletion by prophylactic salpingo-oophorectomy and exemestane, a greater loss in TBS would be observed. One year following prophylactic salpingo-oophorectomy and two years on exemestane did not cause significant loss in TBS. Based on our findings, the clinical use of TBS for detecting small changes in bone is not warranted.