Impact of Pilates Exercises on Bone Mineral Density in Breast Cancer Survivors Receiving Hormonal Therapy

Inclusion Criteria: 1. Female breast cancer survivors aged 40-60 years. 2. Histologically confirmed stage I-III breast cancer. 3. Currently receiving hormonal therapy (aromatase inhibitors) for at least 3 months. 4. At risk of osteoporosis or with low bone mineral density (BMD) defined by T-score ≤ -1.0 at lumbar spine or hip. 5. Medically cleared for exercise, specifically low-to-moderate intensity Pilates. 6. Able to attend supervised exercise sessions three times per week for 12 weeks. 7. Willing and able to provide written informed consent. Exclusion Criteria: 1. Metastatic (stage IV) or recurrent breast cancer. 2. History of osteoporotic fractures in the past 12 months. 3. Severe cardiovascular, respiratory, or musculoskeletal conditions that contraindicate exercise. 4. Uncontrolled hypertension, diabetes, or thyroid disorders. 5. Current use of corticosteroids. 6. Active bone metabolic disease other than osteoporosis (e.g., Paget's disease, osteomalacia). 7. Severe cognitive impairment or psychiatric illness preventing adherence to exercise or supplementation. 8. Known allergy or intolerance to calcium or vitamin D supplementation. 9. Participation in another clinical trial with structured exercise or bone-targeted intervention within the last 3 months.