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Valentina Ninova, Bulgaria

Valja's face is candid, friendly – only the cane she leans on tells of the pain she suffers with every step.

Mrs Valentina Ninova, called Valja by her friends, lives in Pleven, a town in northern Bulgaria. She underwent a hysterectomy in 1992, at the age of 36, and two years later began to suffer pelvic pain.

Valentina Ninova, BulgariaIn retrospect, her pain was probably due to vertebral fractures, but at the time she was treated for a slipped disc, given pain killers and underwent physiotherapy. Although her pain got worse, none of the numerous specialists she consulted could help her.

Like many women worldwide, Valja was bounced from doctor to doctor before being diagnosed in 1997, at the age of 41, with osteoporosis. "It took five years for the doctors to discover that I was a victim of the silent epidemic," she says.

According to Valja's physician, Dr. Delina Gueorguieva, this five-year frustrating odyssey from physician to physician is not untypical, since many otherwise qualified physicians are not trained to recognize the symptoms of osteoporosis. "First comes the visit to the neurologist," she says, "then various clinical tests and X-rays of the vertebrae, when vertebral fractures may be diagnosed, and later the referral to a rheumatologist. Often, it is only then that a patient's bone density is measured and osteoporosis diagnosed".

Valja's life has changed. A highly-trained teacher, she is now too disabled to work and lives with her mother and daughter who help care for her daily needs. She has begun to wear a corset this past year – uncomfortable, but necessary to relieve some of the pain of her vertebral fractures. "I cannot work at all, and my professional life is finished," she says. "My social contacts are limited and I stay home alone."

Is she getting better?

Although Valja is being treated with bisphosphonates and calcium preparations her progress cannot be evaluated in Pleven because there are no bone density measuring facilities in the town. Valja also worries whether she can continue to afford the expensive calcium-rich foods and medications she needs on her small disability pension.

Hopefully other women in Bulgaria will not suffer as much as Valja.

Self-help and activist groups such as "Women Without Osteoporosis", the Bulgarian League for the Prevention of Osteoporosis and the Bulgarian Association of Osteoporosis are supporting patients and lobbying for more diagnostic equipment, improved treatment and reimbursement of therapeutic drugs by the national health insurance fund.

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