Possible treatment with Tildren

[Te Amo's Daddy]

After a long day at Littleton Clinic yesterday, Mo might be qualified into a study using Tildren for his lameness issues. He is scheduled for an MRI this morning and if that comes back "normal" he will start the study. I've done the google search and havent had much success finding out more info....Any help?? Thanks

[deltawave]

There are some big long threads here about Tildren...maybe search here on COTH.

Google is not a very good medical resource! Try Medline or PubMed, or scholar.google.com.

[Te Amo's Daddy]

Thanks. I'm pretty new here but since becoming a member I have learned so much! I'll search the info you gave me.

[Janet]

Here, do a search on both "Tildren" and "Tildrin", as some threads use the wrong spelling.

[wtchy1]

my boss was trying to get this for her retired grand prix dressage horse but I guess it's illegal in the us. She will be glad if they legalize it. She seems to think it's really great stuff. You'll have to let us all know:yes:

[Janet]

my boss was trying to get this for her retired grand prix dressage horse but I guess it's illegal in the us. She will be glad if they legalize it. She seems to think it's really great stuff. You'll have to let us all know:yes:
It isn't "illegal", it just isn't formally approved yet.

The various studies going on are part of the process of getting it approved in the US. If your horse qualifies for one of the studires, there is no charge. If your horse doesn't qualfy for the study, you can still get it (import it from UK) and use it, but it is very expensive.

[wtchy1]

I'll have to let her know, maybe her horse will qualify for the study! That would be great for her. Do you know where I can send her for more info??

Thanks.

[TheOrangeOne]

Huh, I couldn't find anything under a search but it is exam week and my head doesn't work. ETA: I was thinking of tarumeel when I said you can get it at farmvet, and I have no idea about either of them. brain fried.

[Te Amo's Daddy]

We are sitting on the proverbial "pins and needles" waiting to hear how the MRI went at the clinic. I will keep those interested updated.

[dogponyshow]

What is Tildren and what is it used for?

[deltawave]

It is a "bisphosphonate", a drug used for bone remodeling. Similar to Boniva, Fosamax, and other drugs used in humans to prevent or treat osteoporosis. I believe it is being used and/or studied for horses with "navicular syndrome" or other conditions where bone resorption is pathological.

Our very own RAyers, who hangs out on the Eventing board, is a PhD scientist in bone physiology, among other things, and is very expert on the topic. If I'm not mistaken he has some very big reservations about this so-called "wonder drug".

Unfortunately if you start threads on the topic of navicular pain/syndrome/disease, the barefoot-trimming...people...quickly take over and chase everyone away. :sigh:
:lol: However, there are a few good threads on Tildren if you do a search.

[Mary in Area 1]

Make sure you are VERY aware of the possible, negative long-term side effects of this drug before you attempt a quick-fix.

I don't know anyone who has used it who has achieved LONG TERM soundness.

[Te Amo's Daddy]

Now are you personally aware of problems? Can you direct me to any information? We are NOT in the prgram as of yet, but statements like you have made make me somewhat skeptical. Please don't leave me hanging like you have.

[deltawave]

You really should be asking these questions of your vet, no? Skepticism is a fine and healthy thing--wish there were more of it--but as brilliant and well-meaning as all of us are here on COTH :D we are no substitute for the depth of knowledge YOUR vet can provide regarding treating YOUR horse.

[mroades]

The way I understand it laymen's terms from both my vet and what Rayers has said is this: It does create bone (or something that looks like bone) on a x-ray, but that the quality of what you see on the film is actually worse, more brittle if you will. My vet says he only sees a 1 out of 5 improvement on lameness in most horses
So it looks better, more dense on xray, but is actually of less quality.
Rayers, please correct me if I got that wrong!

[RAyers]

Ya'll are right on! Te Amo, PM me and I will help you. I use LLAC as my vets too so I know who to talk to as well.

Tildren is Zolendric Acid (bisphosphonate). In humans it is administered as an infusion rather than as an oral med such as Boniva or Fosamax. This is done in oncology on a regular basis. Tildren is approved in the US for humans. The infusion allows for much higher doses to be administered, however those high doses also lead to the formation of necrotic (dead) bone in the head and jaw. It has been found that zolendronate (Tildren) can actually inhibit certain phosphate proteins in soft tissues leading to their damage as well as in the bone.

Why does the bone in the head and jaw die? Well, it has been shown that bisphosphonate uptake inbone is directly corellated to bone turnover (self-repair). The head and jaw are VERY active, unlike the bones of the lower limbs, so bisphosponates concentrate there, creating focal areas of dead tissue.

Reed

[AKB]

We've used injections of steroid/hyaluronic acid into the navicular bursa and also have used IRAP for our horse's navicular disease, with good results. We were offered Tildren, but since our horse has relatively normal x-rays, were told it would probably not be effective. Tildren did not help our neighbor's horse, who also has fairly normal navicular x-rays.

[lstevenson]

Make sure you are VERY aware of the possible, negative long-term side effects of this drug before you attempt a quick-fix.



What negative side effects have you heard?

I am thinking about giving it to my new horse who is sound but has pretty bad navicular x-rays. My vet recommended that I do it once a year with this horse. But it is so pricey, that I'm on the fence about it.

Reed, I am sending you a PM.

[deltawave]

There's a VAST difference between making X rays look better and making the horse sounder. :)

[horsekpr]

According to 2 vets i consulted,tildren has not scientifically been shown to be of any benefit to horses. That being said there is alot of anecdotal suppport. Katie Prudent uses it quite alot for her jumpers,and swears by it.
I had a regional profusion with Tildren done on my ringbone horse last summer.It was much cheaper than giving it sustemically.This is a pretty new idea,and was affordable to me ,so i thought what the heck,I'll try it. it cost me about 220.00 ,to do his bad pasturn ,and I have to say ,I really feel like it made an improvement in his comfort and soundness. Now this horse will never be sound. I wasn't expecting that. i just wanted to make him more comfortable.Within about a month he was walking much better,infact it was pretty remarkable. Everyone who sees the horse has remarked on how much better he seemed after the treatment.

[lstevenson]

There's a VAST difference between making X rays look better and making the horse sounder. :)

But I have to wonder if making the x-rays look better might keep him sound, or at least prevent more changes. :confused:

And he is sound right now, so I thought of waiting until I start to have soundness problems before I do it. But then I know I would feel guility, like I should have done more to prevent it.

[deltawave]

As I understand it, there is precious little correlation between the appearance of X rays and "navicular syndrome" anyhow. But I'm certainly no expert.

[Meredith Clark]

My horse recieved IV Tildren to help with his kissing spine this past Feb. He was treated at VA Eqine Imiaging and it cost about $1,000. They did not suggest he gets it anymore throughout his lifetime.

Along with shockwave thearpy, turnout 24/7, a strong topline, and small things like great saddle fit, long warm ups and cool downs, the vets there told me that Tildren would be the most important thing in getting him to return to a comfortable state and be able to compete again.

I gave him 6 months off after the treatments and he's just started back in training and I will tell you he is a completely different horse. He used to pin his ears and kick out if you tried to brush his back, now he's trotting around swinging his back and most importantly..he's HAPPY!

[Mary in Area 1]

Did it ever occur to you it might have been the 6 months off that made him more comfortable and happy?

I just don't understand how Tildren is supposed to help kissing spine. Was this Dr. Allen? How did he explain that the Tildren would help?

[ljc]

My horse was considered for a tildren study being done at Alamo Pintado here in California. He didn't qualify due to soft tissue injuries that showed up on the MRI. My regular vet (not with Alamo) has many hunter/jumper trainers who get tildren from France and use it with great success (and it's incredibly cheap over there). I haven't heard of any negative side effects. I also know of many people in California who have used it with their horses. I fully intend to explore using it myself when my horse has finished rehabbing from his soft tissue injuries.

[RiverBendPol]

My daughter and I had Tildren suggested to us about 18 months ago for a horse with a bad navicular xray. After Rayers' thorough description and discussion on these boards, we decided to run for the hills! We did not go for the Tildren for a couple of reasons. One being that the "long term" results aren't in yet bc the drug is fairly new. Nobody really knows how that new 'bone' will behave 10 years from now. I also seem to remember someone suggesting the new 'bone' does not have the density of natural bone which made us think we really wouldn't want to be landing off a 3'6" drop fence on that foot.
(Oh, and guess what, that bad navic is still sound having had one injection to the bursa 18 months ago)

[retrofit]

I am thinking about giving it to my new horse who is sound but has pretty bad navicular x-rays. My vet recommended that I do it once a year with this horse. But it is so pricey, that I'm on the fence about it.

Have you looked into shockwave? Might be a good 1st step and a bit cheaper.

[RAyers]

Sure, no adverse effects are seen now because horses are new users. In humans we are seeing the bad side of this class of drugs after 10 years as patients begin to develop new conditions as the direct result of the drug.

It is not to say I am against the appropriate use of the drug. However, many vets have no understanding of the drug and its modes of action. Thus they prescribe it for things that it will have little effect. Suffice to say, that as this drug takes hold, more horses will develop secondary problems as the direct result of using this drug just as we find in humans.

Reed



My horse was considered for a tildren study being done at Alamo Pintado here in California. He didn't qualify due to soft tissue injuries that showed up on the MRI. My regular vet (not with Alamo) has many hunter/jumper trainers who get tildren from France and use it with great success (and it's incredibly cheap over there). I haven't heard of any negative side effects. I also know of many people in California who have used it with their horses. I fully intend to explore using it myself when my horse has finished rehabbing from his soft tissue injuries.

[lstevenson]

Have you looked into shockwave? Might be a good 1st step and a bit cheaper.


Where I'm at it's almost the same price. Since they recommend 3 treatments, and they are $300 a piece.

I have used shock wave for other things before and love it, think it definitely helps.

But as this horse is sound, I can't see signing him up for shockwave treatments yet. I suppose I should apply the same logic to the Tildren. But as I said before, I was thinking the Tildren may prevent his changes from getting worse. :confused:

[RAyers]

This is not aimed at you lstevenson directly, but,

NO!!!!!!!!

Bisphosphonates are TOXIC! They kill bone resorbing cells. These are the same cells that remove diseased and dead bone in normal healthy tissue. Bone ABSOLUTELY MUST have these cells to be healthy. There IS NO prophylactic use whatsoever. All you would be doing is trading one condition for one that is much more systemic and possibly even more detrimental to the horse.

If you want to understand what the use of Tildren is about, read up on osteoporosis in women and this type of treatment. Go to the National Osteoporosis Foundation (www.nof.org)

Here is a GREAT article about how the QUALITY of bone is MORE important the QUANTITY of bone (which is the only thing you see on an x-ray).

http://www.nof.org/cmexam/Issue11BoneQuality/BoneQuality-forweb.pdf

But as I said before, I was thinking the Tildren may prevent his changes from getting worse. :confused:


Vets should be dong BLOOD TESTS as well to see if Tildren should be prescribed. They should examine the blood for increased inflammatory markers such as alkaline phosphatase and various cyclooxygenases. These are used to determine the necessity of bisphosphonates in humans and should also be used in horses. The claim that a horse need Tildren based on an x-ray is pure IDIOCY. It is like saying that your horse needs colic surgery based on the fact he was kicking at flies.

Reed

[slainte!]

Rayers,

I understand your concern about long term effects, since we are starting to see them in human users of Tildren. However, do you think it's fair to compare the long term side effects in horses?

I say this because, for example, I am sure a lot of you use fly spray or other tick/fly preventitives that are known for having cancer causing agents in them. We spray that all over our horses...... We're careful not to get it on our hands and wash them liberally after use. If it causes cancer in humans it causes cancer in horses, right?

My point is, a human's life span is an average of 75 years. The horse's average life span is about 30. There are certain things that pertain to the horses that do not pertain to us. Could one of these things be the long term side effects of Tildren?

Could you clarify your argument about this Tildren, from this perspective for me?

[RAyers]

Yes I do. We do our testing at normal doses in small animals that are even more short lived than horses and see detrimental effects. So lifespan has no effect. Tildren is administered directly into the body, unlike fly spray. I would expect to see jaw and teeth problems (e.g. brittle teeth shattering) in horses to develop relatively rapidly as these are tissues in horses that see extensive remodeling of the calcium phosphates.

Reed

Rayers,

I understand your concern about long term effects, since we are starting to see them in human users of Tildren. However, do you think it's fair to compare the long term side effects in horses?

I say this because, for example, I am sure a lot of you use fly spray or other tick/fly preventitives that are known for having cancer causing agents in them. We spray that all over our horses...... We're careful not to get it on our hands and wash them liberally after use. If it causes cancer in humans it causes cancer in horses, right?

My point is, a human's life span is an average of 75 years. The horse's average life span is about 30. There are certain things that pertain to the horses that do not pertain to us. Could one of these things be the long term side effects of Tildren?

Could you clarify your argument about this Tildren, from this perspective for me?

[slainte!]

Thank you! That makes things a lot more clear for me to understand!
Do you think the horse world is going to "ok" this drug in the USA? FEI?

When can we expect that to happen, or not happen?

[RAyers]

This drug is approved. It does have significant use, particularly for oncology where many drugs to treat cancer also trash bone. This drug helps spare bone loss while avoiding the common side-effects of bisphosphonates (gastric upset etc.). I see no reason to ban the drug as it does not enhance performance.

What does need to happen is its wise use and not be taken as a cure-all.

Reed


Thank you! That makes things a lot more clear for me to understand!
Do you think the horse world is going to "ok" this drug in the USA? FEI?

When can we expect that to happen, or not happen?

[Hannahsmom]

Here is a GREAT article about how the QUALITY of bone is MORE important the QUANTITY of bone (which is the only thing you see on an x-ray).

http://www.nof.org/cmexam/Issue11BoneQuality/BoneQuality-forweb.pdf

Reed

Reed, can you please post this about ten more times. :) I'm not being sarcastic, I actually really mean it. I saw a paper presented a couple of years ago that opened my eyes to this issue.

[Te Amo's Daddy]

From the Tildren program. Mo had his MRI last night and with the presence of some soft tissue issues.....he won't qualify for the next step. With all I have read "maybe" a good thing!! I am waiting to talk to my trainer regarding his treatment plan after she talked to the Vet this afternoon. I'm sure corrective shoeing/injections/etc. Thanks for all that supplied information and advise. I am a "hooked" coth member! Tim

[dwblover]

I am by no means an expert on this subject, so this is just a question. But I believe they have been using Tildren quite frequently in France for over ten years, haven't they? That is what my vet told me. He has some experience with using Tildren. Apparently you can get a special license and use it in the US now. He said he has treated about twenty horses. One was a barrel horse who was crippled from navicular. They did IV infusion for ten days. Two months later she was sound. It has been one year, and she is still sound. Just food for thought. But I was just wondering what the long-term effects in France have been.

[lstevenson]

From the Tildren program. Mo had his MRI last night and with the presence of some soft tissue issues.....he won't qualify for the next step. With all I have read "maybe" a good thing!! I am waiting to talk to my trainer regarding his treatment plan after she talked to the Vet this afternoon. I'm sure corrective shoeing/injections/etc. Thanks for all that supplied information and advise. I am a "hooked" coth member! Tim


I'm sorry to hear that. :( What soft tissue issues does he have? My top horse is retired from DDFT and Impar ligament damage.

[Meredith Clark]

I just don't understand how Tildren is supposed to help kissing spine. Was this Dr. Allen? How did he explain that the Tildren would help?

The way it was explained to me, and I am by no means a vet, and I was crying hysterically (no one wants to hear that their event horse has a degenerative bone condition), was that the vert. in his spine were rubbing together and causing cists and liasons. This was causing the bone to break down sorta like osteoporosis in people.

[Nadonyalife]

A note of caution about the Tildren:

I treated a horse with this last spring at the recommendation of a vet after an MRI showed unusual navicular wear & tear. Within 72 hours, the horse colicked. Ended up having to have surgery.

Did not assume any connection UNTIL the vet who gave the Tildren told me that there is at least anecdotal evidence that Tildren can sometimes set off these episodes....It seems that the drug can cause calcium levels to drop dramatically. Had I known this AHEAD of time, would have arranged to give the drug under different circumstances (e.g., closer veterinary supervision) with blood levels closely monitored.

[europferde]

I too treated a dressage horse that has kissing spines with Tildren two years ago. He was so miserable it was to the point that I couldn't ride him he was so naughty (rearing, bucking...)!!! My vet thought injections or shockwave was probably pointless he was so bad. We followed the IV protocol for 10 days, gave him a few weeks off and then started him up again. He's very particular about his warm up. That means lots of stretching in all three gaits and then he's good to go. We did not combine this with any other treatment. Correct work and a strong topline combined with the Tildren really worked. Just my two cents.

www.europferde.com

[tanflorence]

I think its great stuff. The primary effect of Tildren to inhibit bone resorption. It will be affected in the blood. It could not treat the blood calcium. To reduce damage to the bone.

----------------------------------
Kentucky Drug Treatment (http://www.drugtreatments.com/kentucky)

[Sunny's Mom]

I just got a mailing from the wisconsin vet equine clinic about this. My horse is located in CO, so its not very conveniently located. I'll have to ask LLAC about it, since my horse is being seen by Tisher.

I mean really, if a horse can go from dead lame to better, even if its only for a short period of time, isn't that better than straight retirement? Or are the side effects such that they need to be put down after a few more competition years?

[touchstone-]

Somewhat tangential, but I thought I'd pass along this New York Times piece from a few months back linking biophosphonate use to femur fractures in women. It's a pretty anecdotal account, but this combined with RAyers's informative posts would make me quite reluctant to try Tildren when there were more tested options available.

http://www.nytimes.com/2008/07/15/health/15well.html?ref=health

[Horsejudge]

Who tried it in the meantime?

Where can we get the best deal on it?

Any more info? Did any of you use it for OCD? If so, what results did you experience?

[Cat Tap]

I posted a new thread on Tildren before I found this one.

My horse was diagnosed with progressive navicular changes. He is very uncomfortable on both front.

Tildren seemed to be my only option. I have no first hand experience with this but have read that it has been used in Europe for some time quite successfully.

Nerving was another option though my vet was reluctant about this stating that it does not solve all problems.

The third option was to euthanise. For this reason I was not concerned about long term effects. At least Tildren may give me a few more years with this horse.

We started the injections two days ago. So far so good. My vet feels that I should be able to start hacking him in the fall. I hope he is right.

I was hoping to hear about some successful outcomes from others who have used this treatment.