Background: Osteoporosis is considered a late effect of breast cancer treatment. Previous studies included predominantly European-American women and analyzed African-American (AA) survivors in aggregate, despite their known differences in bone mineral density. Our purpose was to examine the prevalence of osteoporosis in a sample of exclusively AA women. Methods: This cross-sectional study included 111 overweight or obese AA women, aged 31-80 years, previously diagnosed and treated for stage I-IIIa breast cancer. Women completed questionnaires and underwent dual energy x-ray absorptiometry and phlebotomy prior to their enrollment in a weight loss intervention. Participants were categorized as having normal bone density, low bone mass or osteoporosis using the WHO definition for femoral neck T-scores. Results: Despite the frequent use of adjuvant hormone therapies (45%), a decreased ability to absorb ultraviolet light (54% reported dark/very dark skin), suboptimal intake (diet + supplements) of calcium and vitamin D [949 (± 569) mgs and 325 (± 231 IUs), respectively], the infrequent use of bisphosphonates (7%), and a high occurrence of vitamin D insufficiency/deficiency (49% had serum 25(OH)D levels <20 ng/ml), the prevalence of osteoporosis and low bone mass was <1% (n=1) and 16% (n=17), respectively. The 10-year probability of a major osteoporotic fracture was 2.4%. Age (p=0.004) was the only significant predictor of compromised bone health. Conclusions: These findings challenge the clinical assumption that osteoporosis is highly prevalent among all breast cancer survivors, providing foundational evidence to support differences by race/ethnicity and reiterating the necessity of regular dialogue concerning nonpharmacologic preventative options (e.g., diet and physical activity).