Tiludronate’s Safety for Navicular Treatment Studied

Researchers determined that tiludronate is safe to use in horses as directed.
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Navicular syndrome is a common performance-limiting disease of the equine foot that involves abnormal bone remodeling of the distal sesamoid (navicular) bone. For more than a decade, veterinarians in Europe have used the bisphosphonate drug tiludronate disodium, to treat this condition. Tiludronate modifies the remodeling process in these cases by inhibiting excessive bone demineralization and resorption activity by cells responsible for bone turnover called osteoclasts. In humans, tiludronate has been shown to improve bone formation and normalize bone turnover without affecting normal bone function.

The drug (marketed as Tildren) received FDA approval for use in the United States in December after veterinarians stateside performed a number of clinical trials demonstrating the drug’s safety and efficacy.

At the 2014 American Association of Equine Practitioners (AAEP) Convention, held in Salt Lake City, Utah Dec. 6-10, Valentine Williams, DVM, MS, Dipl. ACVS, of Tildren manufacturer CEVA Animal Health, presented the results of the safety studies involving intravenous infusion of tiludronate.

In one exaggerated dose study, which is designed to determine what—if any—side effects an overdose would cause, researchers administered various concentrations of intravenous tiludronate. The most common sign they observed in both treated and untreated control horses was discomfort defined as “colic.” The team noted, however, that horses were restrained for long periods in stocks, and inactivity on top of drug administration could have been to blame. The only significant clinical abnormality they observed was decreased ionized calcium and increased serum phosphate in the horses’ blood, both of which normalized within 72 hours following treatment. Williams pointed out that bone mechanical strength and tissue in bone remodeling units (cells that remove and form bone) were all normal. From a safety standpoint, exaggerated doses had few negative effects, the team determined

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Written by:

Nancy S. Loving, DVM, owns Loving Equine Clinic in Boulder, Colorado, and has a special interest in managing the care of sport horses. Her book, All Horse Systems Go, is a comprehensive veterinary care and conditioning resource in full color that covers all facets of horse care. She has also authored the books Go the Distance as a resource for endurance horse owners, Conformation and Performance, and First Aid for Horse and Rider in addition to many veterinary articles for both horse owner and professional audiences.

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