 Primary amenorrhea is characterized by delayed menarche (the onset of menses during puberty).Delayed menarche may be associated with delay of the development of secondary sexual characteristics.Osteoporosis is defined by the National Institutes of Health as ‘‘a skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture.’’ Low estrogen levels and poor nutrition, especially low calcium intake, can lead to osteoporosis, the third aspect of the triad.