Osteoporosis is a systemic disease characterized by decrease in bone mass per unit volume, compromisedbone strength, which predisposes the affected bone to fracture. This is currently one of the leading causes ofmorbidity and mortality among elderly over the world. In general, osteoporosis is a silent and progressivedisorder that is often brought to attention of the patients or physician only after a fracture. The aetiology ofosteoporosis is multifactorial and is related to two main processes: acquisition of peak bone density thatoccurs at the end of the third decade and loss of bone at menopause, going on to old age. The cardinalfeatures of osteoporosis are pain, fracture and deformity. Bone mineral density measurement is the mostreliable diagnostic tool in the early stage of osteoporosis. Management of osteoporosis involves preventionand treatment. The best treatment for osteoporosis is prevention. The risk of osteoporosis can be reduced byincreasing peak bone mass or by decreasing the bone loss. It needs to be emphasized that bone mineraldensity (BMD) peaks at about age 35 and then begins to slowly decline with significant acceleration aftermenopause. Therefore, the most logical and cost-effective preventive strategies are to encourage young womento stop smoking and avoid excessive use of alcohol. They should also be counseled to exercise regularly andconsume adequate amounts of calcium and vitamin D.Key Words: Osteoporosis, Fracture, Bone mineral density, Menopause.

Introduction: Traumatic lower extremity injuries requiring multidisciplinary treatment pose a challenge in low- and middle-income countries, where access to specialists may be limited. The surgical management and reconstructive training (SMART) course teaches orthopaedic surgeons muscle and fasciocutaneous flap procedures to address this scarcity. The purpose of this study is to assess the effectiveness of the SMART course in improving competency and comfort in performing common lower extremity flap procedures among participants. Methods: Sixty-four orthopaedic surgeons from different regions of Nepal and Bhutan participated in the Nepal SMART course in 2016 and 2017. A competency test—consisting of questions from US in-training plastic and orthopaedic surgery examinations—was administered to attendees before and after the course. Thirty-two participants from 2016 were asked to rate their comfort level in performing flap procedures both pre- and postcourse. Results: Overall competency test scores, as well as scores in the plastic surgery section, increased significantly after the course (P < 0.01). The precourse competency test scores were higher in 2016 compared with 2017 (P = 0.02). There was a higher increase in overall competency test scores after the course in 2016 compared with 2017 (P = 0.03). The procedure comfort levels reported by attendees increased for all flaps (P < 0.01). Conclusions: These results demonstrate the ability of the SMART course to improve the competency and comfort levels of orthopaedic surgeons in performing common lower extremity flap procedures. Despite the differences in years in practice and previous experience in performing flaps, the course yielded significantly better results in 2017 compared with 2016, showing that the implementation of the course has been improving.

Introduction: Osteoporosis represent a worldwide public health problem, frequently resulting in fractures and leading to psychological problem, social consequences, functional limitation and poor quality of life. So it is important to identify those people who have high risk of osteoporosis, in order to reduce the incidence of osteoporotic fractures. The Osteoporosis Self-Assessment Tool for Asians (OSTA) index is a simple tool based on age and body weight. Calcaneal quantitative ultrasound (QUS) is another simple and low-cost instrument used to prescreen osteoporotic subjects. The aim of this study was to correlate between these two screening methods and to validate usefulness of Osteoporosis self assessment tool for Asian ( OSTA) in comparison with QUS of the calcaneum for the prediction of low bone density in Nepalese women. Methods: This was a two-year descriptive observational study comprising 100 subjects performed at TU Teaching Hospital, Kathmandu, Nepal, from 2007 January to 2009 January who completed semi structured questionnaire with subsequent measurement of Quantitative Ultrasound (QUS) of the calcaneum. The sensitivity, specificity, and diagnostic accuracy of OSTA index was validated with the QUS T-score. Results: When the risk category was defined as OSTA index ≤ -1, and low QUS value as t-score ≤ -2.5, the sensitivity, specificity and diagnostic accuracy of the index were 93.3%, 56.5%, and 62% respectively, and the area under the curve was 0.7651. When the low QUS value was taken as t score ≤ -1.0, the sensitivity, speciÞ city and diagnostic accuracy was 85.2%, 89.1% and 87% respectively. Conclusions: The OSTA index, a simple and free risk assessment tool, can be used to estimate the prevalence of low QUS values in Nepalese women and may help to increase awareness and prevention of low bone mineral density. DOI: http://dx.doi.org/10.3126/noaj.v3i2.9524  NOAJ July-December 2013, Vol 3, Issue 2, 20-25

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