The Horse:Your Guide To Equine Health Care provides monthly equine health care information to horse owners, breeders, veterinarians, barn/farm managers, trainer/riding instructors, and others involved in the hands-on care of the horse.
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40 TheHorse.com THE HORSE September 2015 provides a chance for the horse to get back moving and being useful." Your veterinarian can provide addi- tional detailed information regarding the costs, odds, risks, and potential benefits to help you make an informed decision as to what's best for you and your horse. Finally, we'd be remiss if we didn't mention one equally important player on your horse's hoof-care team: the farrier. Proper trimming and shoeing— corrective, if needed—are just as essential as good veterinary care in managing chronic hoof conditions. "With good farrier work and a good di- agnosis, we may be able to keep the horse going," says Snyder. Some Answers, but Questions Remain Which modality is the most effective for treating which problem? That hasn't yet been quantified, our sources say. "Studies have not been done yet of the efficacy and comparison of treatment modalities. They need to be done," says García-López. The difficulty lies in the challenge of lining up appropriate study subjects—horses with similar injuries and histories, so researchers can compare treatment responses in an apples-to- apples fashion. The problem, of course, is that no two horses are the same and no two injuries are the same; so it will take a while to amass conclusive findings. For now, there's a bit of let's-cross-our-fingers- and-hope-this-helps in the decision- making process. "There have been some small studies, but no big, blinded studies comparing the new modalities we have now," says Snyder. Furthermore, it's not yet completely understood exactly how some of these treatments work. "We have a long ways to go with (understanding) stem cells and PRP," says Snyder. As for ESWT, "how it interacts with tissue is up for debate," he says. Similarly, the long-term effects of bisphosphonate use in horses have not been studied either. In Snyder's view, veterinary medicine has advanced to the point that we're just beginning to explore the new therapies' potential. Beyond our current applica- tions and expectations, "I think stem cells and growth factors will be cutting-edge," he says. "In the future, there will be spe- cific ways of stimulating specific tissues." The Tide is Turning "These modalities have more effect than doing nothing," Snyder says. For example: "In the 1980s, only 20 to 30% of horses with a bad high suspensory injury would recover. With the use of shock wave, it's up to 60 to 70% in some studies." García-López concurs. "In horses with tendon lesions at the level of the navicular bone and bursa, a good number—around 65 to 70%—can come back to an accept- able level of soundness" (although erosion in the navicular bone brings that statistic STEP BY STEP Bisphosphonate For use in horses only. Brief Summary (For Full Prescribing Information, see package insert) CAUTION: Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian. DESCRIPTION: Clodronate disodium is a non-amino, chloro- containing bisphosphonate. Chemically, clodronate disodium is (dichloromethylene) diphosphonic acid disodium salt and is manufactured from the tetrahydrate form. INDICATION: For the control of clinical signs associated with navicular syndrome in horses. CONTRAINDICATIONS: Horses with hypersensitivity to clodronate disodium should not receive OSPHOS. WARNINGS: Do not use in horses intended for human consumption. HUMAN WARNINGS: Not for human use. Keep this and all drugs out of the reach of children. Consult a physician in case of accidental human exposure. PRECAUTIONS: As a class, bisphosphonates may be associated with gastrointestinal and renal toxicity. Sensitivity to drug associat- ed adverse reactions varies with the individual patient. Renal and gastrointestinal adverse reactions may be associated with plasma concentrations of the drug. Bisphosphonates are excreted by the kidney; therefore, conditions causing renal impairment may increase plasma bisphosphonate concentrations resulting in an increased risk for adverse reactions. Concurrent administration of other potentially nephrotoxic drugs should be approached with caution and renal function should be monitored. Use of bisphos- phonates in patients with conditions or diseases affecting renal function is not recommended. Administration of bisphosphonates has been associated with abdominal pain (colic), discomfort, and agitation in horses. Clinical signs usually occur shortly after drug administration and may be associated with alterations in intestinal motility. In horses treated with OSPHOS these clinical signs usual- ly began within 2 hours of treatment. Horses should be monitored for at least 2 hours following administration of OSPHOS. Bisphosphonates affect plasma concentrations of some minerals and electrolytes such as calcium, magnesium and potassium, im- mediately post-treatment, with effects lasting up to several hours. Caution should be used when administering bisphosphonates to horses with conditions affecting mineral or electrolyte homeosta- sis (e.g. hyperkalemic periodic paralysis, hypocalcemia, etc.). The safe use of OSPHOS has not been evaluated in horses less than 4 years of age. The effect of bisphosphonates on the skeleton of growing horses has not been studied; however, bisphosphonates inhibit osteoclast activity which impacts bone turnover and may affect bone growth. Bisphosphonates should not be used in pregnant or lactating mares, or mares intended for breeding. The safe use of OSPHOS has not been evaluated in breeding horses or pregnant or lactating mares. Bisphosphonates are incorporated into the bone matrix, from where they are gradually released over periods of months to years. The extent of bisphosphonate incorporation into adult bone, and hence, the amount available for release back into the systemic circulation, is directly related to the total dose and duration of bisphosphonate use. Bisphosphonates have been shown to cause fetal developmental abnormalities in laboratory animals. The uptake of bisphosphonates into fetal bone may be greater than into maternal bone creating a possible risk for skeletal or other abnormalities in the fetus. Many drugs, including bisphosphonates, may be excreted in milk and may be absorbed by nursing animals. Increased bone fragility has been observed in animals treated with bisphosphonates at high doses or for long periods of time. Bisphosphonates inhibit bone resorption and decrease bone turn - over which may lead to an inability to repair micro damage within the bone. In humans, atypical femur fractures have been reported in patients on long term bisphosphonate therapy; however, a causal relationship has not been established. ADVERSE REACTIONS: The most common adverse reactions reported in the feld study were clinical signs of discomfort or nervousness, colic and/or pawing. Other signs reported were lip licking, yawning, head shaking, injection site swelling, and hives/pruritus. Distributed by: Dechra Veterinary Products 7015 College Boulevard, Suite 525 Overland Park, KS 66211 866-933-2472 © 2015 Dechra Ltd. OSPHOS is a registered trademark of Dechra Ltd. All rights reserved. NADA 141-427, Approved by FDA OSPHOS ® (clodronate injection) The author's mare, Diamond, underwent platelet-rich plasma and stem cell therapy to treat the le- sion in the deep digital fexor tendon around one of her pastern bones. COURTESY JENNIFER O. BRYANT