Tuesday, September 1, 2009

Tildren, a new drug for bone disorders (part 1)

I don't know if I have ever mentioned this, but I have osteopenia (precursor to osteoporosis). I take Actonel, a drug that increases bone density. Unlike most drugs I've taken or considered, I took Actonel without really knowing how it worked--as a rider and young horse owner I am just thankful that it does work.

Now there's a horsey-equivalent
And now, for horses with navicular, ringbone, hock, or other bone issues, there is an IV drug called Tildren. If you follow equine medicine, you've almost certainly heard of it. But if you haven't, here's a layman's description. Standard disclaimer: I'm no expert -- think of this info as something you overheard in the barn aisle. Read the authoritative resources if you want the more authoritative scoop.

Bones: Always under construction
Bone tissue is always under construction, it's normal for both humans and horses. When bones experience heavy loading (e.g., concussion, weight-bearing work), the tissue tries to rebuild itself and become stronger/denser. That's why my doctor recommended weight lifting to combat my bone problem. But excessive work produces an inflammatory response and excessive remodelling that ultimately weakens the bone. Here's some detail on how that happens.

Goofus and Gallant of the skeletal realm
Two types of bone cells play a part in bone remodeling: osteoclasts, "bone nibblers," tear down bone (see picture, above, from Tildren brochure). Osteoblasts, bone builders, create new bone. In normal bone, they work together to maintain bone health, but osteoblasts work more slowly than osteoclasts. When the remodelling process goes into overdrive, osteoclasts tear down bone faster than osteoblasts can rebuild it -- so more bone is lost than gained.

Tildren to the rescue
Tildren stops the osteoclasts from breaking down the bone -- kills the cells actually -- which gives the osteoblasts a chance to work. Over the course of months this increases bone density. Tildren works best on horses who have been unsound for six months or less, and the results vary. When it works, the difference is visible on x-rays and horses are noticeably more sound.

Late to the party
Tildren is not yet been approved by the FDA (as far as I can tell) but vets in the U.S. who go through special licensure are able to obtain it through the FDA and prescribe it. Judging from COTH posts, a lot of horse owners are getting treatment for their horse. Is it really as great as the hype suggests? In Veterinary News, one U.S. vet made an interesting comment that suggests how effective Tildren is...


"A while or so back we would receive mature performance horses with long careers imported from Europe with reasonable radiographs and no lameness issues when they arrived," explains Warsham. "Then, for no reason, after a while, they would develop any number of lameness issues. We started thinking that they (European owners, trainers and veterinarians) must have had something, probably Tildren, that they were using to help keep these 'older soldiers' sound."

Judging from that comment alone Tildren seems to be extending the useful life of many horses. That's really great news! But experts warn that it is an imperfectly understood treatment of degenerative processes (navicular, arthritis, etc.) that also are not well understood. Either the men of modern medicine are being too modest (which I doubt), or we just manage to stumble onto treatments. In any case, I'm sure glad these human drugs are being applied in equine medicine.

More in Part 2 of this series, Treating with Tildren (what to expect)...



RESOURCES

Bone Quality from the National Osteoporosis Foundation (a good primer)

Information on Tildren from Georgevetgroup.co.uk

Navicular disease in horses from Equinehorsevet.com

Tildren discussion on COTH (featuring Reed Ayer, credentials at the bottom of the thread)

Should you consider Tildren for navicular? from Horse Journal (requires login, darn it)

French drug shows potential for navicular therapy Equus Magazine, Nov 2003

Navicular disease: New treatment from Equine Science Update

Navicular disease and spavin: New treatments from Equine vet/podiatrist (blog)

Tildren brochure (from Tildren manufacturers of course, but very nice illustrations)

Tildren: Denoix study shows Tildren helps with back pain from Fran Jurga's blog

Promising new navicular therapy from Equisearch.com

Treating Navicular Disease From inside the bone
from The Horse magazine

Evaluating treatment choices for tendon, ligament injury and joint disease in the horse from Veterinary News

Tildren drug therapy
, a forum posting by a DVM

Tildren, the Magical Product against Lameness?! from Eurodressage

Equine Bone Fragility Disorder
reported in California from The Horse magazine

Footnotes
1 Horse and Hound online forum


6 comments:

  1. Now this is an interesting twist on what I have observed in the past. More often than not, it has been the horse industry/vets on the forefront of using new drugs before they become recognized in the human world.

    Glucosamine was widely used in veterinary medicine before it became a treatment in humans. Much of the stem cell treatments now just becoming available to humans were first used in horses. Just read about a hyranlonic acid oral supplement for horses...again not yet widely used for humans.

    Tildren is intriguing. I will have to look it up. Thanks.

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  2. Interesting development. Had a friend who just started her mare on this. Huge adverse reaction after the first treatment, just a warning to all to get details from your doc/vet about side effects and what to watch out for. Scary couple of days for everyone at the barn watching the mare try to get back to stasis.

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  3. Interesting development. Had a friend who just started her mare on this. Huge adverse reaction after the first treatment, just a warning to all to get details from your doc/vet about side effects and what to watch out for. Scary couple of days for everyone at the barn watching the mare try to get back to stasis.

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  4. This was a "down the road" option we discussed after our last round of x-rays for mild navicular. What I was told, is that to be effective the drug must be used in a series of atleast 2 treatments... and since it is pricey we would clearly be able to see if it was helping after the first dose. If we dont see the effect we dont continue. As far as the drug works with navicular, its pretty unclear- it helps some and not others... but with various degrees and other involvement in navicular cases, it made sense. They basically said we wont know if it will help unless we try, and we are not to the point of wanting to go this route yet- but it was suggested as the best next course of action for my guy, so ill be interested to follow others' stories.

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  5. I have used Tildren on a few of my show jumpers. The results have been fantastic. However, Tildren is VERY expensive!

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  6. My 9year old cob had a Tildren infusion a week ago and we have just started out on the 30mins 5 days a week walking maintenance programme. he took the infusion no problems and we took him home same day and he was happy and settled. he is in a pen on his own outside instead of box rest(he kicks the doors) but with horses in field next to him and stabled at night. i am having to use our school to walk him at the moment as after the scintigraphy they took off his front shoes and my farrier has not been well but hopefully will get him reshod next week so i can get him out on the road and flat and see how he feels. he seems to be walking out well initially in the school but he does get bored after 15 - 20 mins (he hates schooling) however he keeps trying to trot, after speaking with vet today he said that sounded optimistic and good that he was trying to trot himself. he has also been put onto a VERY expensive supplement (vets always like to recommend) however after using this to load him, i have found a better more resonable one that includes ha and msm which this EXPENSIVE one doesn't have. he has spavins in both hocks, slight navicular changes in front feet and arthritis starting in his stifle, so we are against a lot of things. i'm to monitor his progress for 3 weeks then vet wants to reassess and see if we need to do a 2nd infusion. he has said that if after a 2nd infusion there is no change then tildren isn't going to work for him, they are finding 1 in 4 succsess rate at my practice using this so i'm hoping i'm one of them.

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