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  1. #1
    Join Date
    May. 23, 2002
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    Default TILDREN

    I'd like to hear from those of you with knowledge of/experiences with Tildren for front leg lameness. I'm aware that navicular is the most common condition it's used for, and hock issues... but my questions are:

    1. Is it given as a joint injection? Or in the vein? If both, what is the reason/effectiveness for one over the other?

    2. I have heard of it being injected in the muscle (neck), is this true, and if so, how does it work??

    3. Are there any reasons (other than its high cost) not to use it (in other words, are there any side effects you're aware of)?

    4. Is stall rest or handwalking necessary after treatment, or is exercise recommended?

    5. Dosage and frequency??

    We're interested in it for an older horse with ankle arthritis and an older coffin bone injury, as well as old torn adhesions/calcifications that are easily aggravated (front legs). We'd do anything to make this horse more comfortable. Limited riding at the moment, only some hacking around on good days, when indicated.

    Will be discussing with my vet soon but would also like to gather your feedback and input, if any.
    "I have never let my schooling interfere with my education." - Mark Twain



  2. #2
    Join Date
    Aug. 22, 2009
    Location
    Indiana
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    870

    Default

    Tildren is given intravenously. You can either mix the vials (their are twenty vials, ten of which containing the drug in powder form and the other ten contain the dilutant) and and give one shot once a day for ten days.

    Tildren is said to be helpful in any chronic bone condition (ringbone, navicular, osteoarthritis of the hock, etc.).

    The drawbacks besides the cost and getting your hands on it is that some horses are a bit colicky after receiving the injection. The other is that there are some withdrawal times so it cannot be used while the horse is in competition (though I don't think that would be a problem in your case!).

    Good luck with your horse! It'd be great to hear if you try this and how it works for him-- I've heard many good things about Tildren but not a lot of feedback from people who have used it first-hand.
    Quote Originally Posted by RugBug View Post
    Don't throw away opportunities because they aren't coming in exactly the form you want them to.



  3. #3
    Join Date
    Dec. 15, 2005
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    3,660

    Default

    Tildren is a cousin of the human bone building drugs Fosamax and Boniva.

    We have given Tildren by regional perfusion to our 22 year old horse who has navicular. It is much cheaper to give 1 vial by regional perfusion (injected into the lower leg only while a tourniquet holds it in place for a few minutes) than to give multiple doses IV. I have never heard of giving it IM and don't know if that is safe.

    Our horse has had many treatments of everything we can imagine (IRAP, navicular bursa injections, Legend, Adequan). Navicular bursa injections of steroid followed by Tildren a week or two later, seems to be effective right now.

    I would suggest you take your horse to your vet school or other large referral clinic to have him seen by a well regarded, board certified, surgeon who does lots of lameness work. They can review your options. Then, they can treat or your local vet can follow their instructions to treat.



  4. #4
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    May. 23, 2002
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    Default

    Thanks. So, is there an alternative to the 10-day IV treatment, in other words, can you give it all at once? If all at once, is it via catheter I assume? While more expensive, is it possibly more effective? And more risky in terms of colic-y reactions?

    Thanks for tolerating and answering my questions! I appreciate all feedback. Happy to know there are some horses out there who've responded well. I wonder if there are any studies taking place, or that have been recently completed.
    "I have never let my schooling interfere with my education." - Mark Twain



  5. #5
    Join Date
    Dec. 21, 2009
    Posts
    740

    Default

    It can be given all at once-- all the people I know have used it that way. But I think you have more chance of a colic with the large dose, so you definitely have to keep an eye out.

    My trainer has used it on a few horses for general stiffness/mild soundness issues and had great responses from all of them. I thought about trying it on my older guy... if he gets back in shape and survives the summer heat, I may do it next fall.



  6. #6
    Join Date
    Dec. 15, 2005
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    Default

    What we do is 1 vial of Tildren, given by the regional perfusion leg injection, about every 6 months. We do it a week or two after his navicular bursa steroid injection. I think Tildren costs about $120 per bottle, but that is just a guess. The regional perfusion injection will cost some money because it involves about 40 minutes of the vet's time and sedation. Not every vet knows how to do regional perfusions. Your costs will be higher if you are treating more than 1 leg.

    I don't know why Tildren helps our guy because his x-rays are fairly normal. However, we love the old guy and have tried a lot of treatments so we can keep him comfortable most of the time.



  7. #7
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    Dec. 15, 2005
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    Default

    What are most people paying for Tildren?



  8. #8
    Join Date
    Aug. 22, 2009
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    Indiana
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    Default

    The oral form of Tildren certified for use in humans is known generically as "tiludronate disodium" or "tiludronate". It's typically found by the brand Skelid.

    A larger study took place (in '08?) throughout the US including at the Wisconsin Equine Clinic and Hospital to see how well it worked in horses with navicular. I'm not sure if any other studies have taken place.
    Quote Originally Posted by RugBug View Post
    Don't throw away opportunities because they aren't coming in exactly the form you want them to.



  9. #9
    Join Date
    Feb. 5, 2007
    Location
    FL
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    Default

    Tildren has been used for 10 yrs or more in Europe with good (over 80%) success. As usual we are way behind due to "red tape" over here.
    Just finished a 10 day with a horse with navicular. 10cc of banamine pre tx. Didn't have any issues with grumbly tummy. He obviously had a catheter so couldn't be turned out so I hand grazed him 2 or 3 times a day...
    We will monitor him over the next few months to see how he progresses.
    From all the reports I've heard (mainly from europe) it would be well worth trying.



  10. #10
    Join Date
    Mar. 23, 2009
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    Paddle faster! I hear banjo music...
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    Default

    We have Tildren administered IV over the course of several hours. I've had luck with 90% of the horses that received it but it is expensive and should be used as a last resort IMHO. Longevity of effects vary from horse to horse. I have some that have stayed sound for 6 months and others 2 years.
    "ronnie was the gifted one, victor was the brilliant intellect, and i [GM], well, i am the plodder."



  11. #11
    Join Date
    Jul. 10, 2001
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    6,723

    Default

    Get ready for some interesting future diseases and conditions in horses.

    Tildren is used in humans, in particular to control bone resorption in rheumatoid arthritis. A similar form is Reclast, zolendric acid, which has a slightly different benzene ring than Tildren.

    It is done as an infusion (long period IV) as it disrupts smooth muscle calcium receptors in the gut, hence the colicing in both humans and horses. By doing slow infusion this is reduced.

    Our research group did numerous studies to see if these drugs (bisphosphonates) could offset microgravity induced osteoporosis back in 1990s. Working with one of the orginal developers of bisphosphonates, I am currently looking at using the phosphonate hook to increase bone incorporation into calcium phosphate bone tissue scaffolds.

    An interesting study published in the March issue of Bone describes the fact that bisphosphonates INHIBIT blood vessel formation in bone, this retards healing (as described in a past article that showed delay fracture healing in bones) as well as inducing the disease Osteonecrosis of the Jaw (ONJ).



  12. #12
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    May. 23, 2002
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    Default

    RAyers, for the reasons you mention, would you have the same hesitations for administering Tildren to an aged horse as you might for a younger one? I'm talking 20's.
    "I have never let my schooling interfere with my education." - Mark Twain



  13. #13
    Join Date
    Jun. 4, 2006
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    2,528

    Default

    Quote Originally Posted by RAyers View Post
    Get ready for some interesting future diseases and conditions in horses.

    Tildren is used in humans, in particular to control bone resorption in rheumatoid arthritis. A similar form is Reclast, zolendric acid, which has a slightly different benzene ring than Tildren.

    It is done as an infusion (long period IV) as it disrupts smooth muscle calcium receptors in the gut, hence the colicing in both humans and horses. By doing slow infusion this is reduced.

    Our research group did numerous studies to see if these drugs (bisphosphonates) could offset microgravity induced osteoporosis back in 1990s. Working with one of the orginal developers of bisphosphonates, I am currently looking at using the phosphonate hook to increase bone incorporation into calcium phosphate bone tissue scaffolds.

    An interesting study published in the March issue of Bone describes the fact that bisphosphonates INHIBIT blood vessel formation in bone, this retards healing (as described in a past article that showed delay fracture healing in bones) as well as inducing the disease Osteonecrosis of the Jaw (ONJ).
    Lets say you have a fairly young horse less than 10 with navicular pain would the benefits outway the concerns in your opinion or would you avoid it? Can you explain the risks in very simple terms I am interested. Also should this drug only be a last ditch effort or be done sooner?
    Last edited by Fharoah; Mar. 27, 2010 at 03:15 PM.



  14. #14
    Join Date
    Dec. 15, 2005
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    Default

    Reed,
    I agree with you that we will cause new problems by administering bisphosphonates to horses, particularly long term. However, for our 22 year old horse, there is no long term. If he isn't comfortable in the field, he will be put down. Since the Tildren (and other assorted treatments) make him comfortable, he is still with us. If he gets a complication from Tildren, I think we will have reached the end of the line.

    I do hope someone is watching so we will recognize the problems and side effects that we create with these meds. I am much happier giving a regional perfusion of 1 vial of Tildren every 6 months than I would be with giving large doses IV. Perhaps I am deluding myself, but I don't worry about the safety of Tildren in our situation.



  15. #15
    rileypcoltrain Guest

    Default

    Quote Originally Posted by cottagefarm View Post
    Tildren has been used for 10 yrs or more in Europe with good (over 80%) success. As usual we are way behind due to "red tape" over here.
    Just finished a 10 day with a horse with navicular. 10cc of banamine pre tx. Didn't have any issues with grumbly tummy. He obviously had a catheter so couldn't be turned out so I hand grazed him 2 or 3 times a day...
    We will monitor him over the next few months to see how he progresses.
    From all the reports I've heard (mainly from europe) it would be well worth trying.
    Just wondering how you made out with your tildren treatments?



  16. #16
    rileypcoltrain Guest

    Default Tildren?

    My mare 6 year old appendix mare was just diagnosed with early signs of navicular. My vet suggested Tildren, just interested in comments/opinions of anyone that has taken this route and their thoughts on its success rates. He suggested the 10 day IV administration but I have also heard of using a turnoquet to administer it to the specific location.



  17. #17
    Join Date
    Jul. 9, 2004
    Location
    New England
    Posts
    54

    Unhappy Tildren possible contributor to fractured pelvis??

    My horse received 2 tildren treatments via the large dose IV, one month apart approximately 5 years ago for some osteolysis in his hocks. It did seem to help him and he reached Grand Prix dressage. 4 months ago, at 18 years old, my horse broke his pelvis (complete fracture and displacement of tuber coxae, about 3-4 inches in from end, as well as another smaller fracture on the concave part of ilial wing). I found him like this in his stall in the morning, no sign of struggle or distress. He is a large horse, but it seems like this sort of injury would have needed a huge amount of trauma to cause it. In reading more and more about how Fosamax causes spontaneous fractures in humans, I'm afraid that the Tildren may have had something to do with my horse's injury?????? Any thoughts on this?
    My special horse now has to be retired from dressage due to this horrible injury.



  18. #18
    Join Date
    May. 22, 2002
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    where the grass is greener
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    Default

    Quote Originally Posted by AKB View Post
    Tildren is a cousin of the human bone building drugs Fosamax and Boniva.

    We have given Tildren by regional perfusion to our 22 year old horse who has navicular. It is much cheaper to give 1 vial by regional perfusion (injected into the lower leg only while a tourniquet holds it in place for a few minutes) than to give multiple doses IV.
    That's how my vet administered Tildren to treat my horse's hock injury. We were told to give him 3 days off and then resume light work. Movement was necessary to promote healing.
    We were pleased with the results considering prognosis was not good after the initial injury.

    Total cost was about $500 - including x-rays, sedation, Tildren, and assistant to hold the horse for the duration of the perfusion treatment (30 mins). The vet also pre-treated for stomach upset.
    You're entitled to your own opinion, not your own facts!



  19. #19
    Join Date
    Dec. 28, 2006
    Posts
    73

    Thumbs up So far, so good

    My horse has just finished a course of Tildren to treat his bony navicular syndrome pathologies (in his case: moderate-marked disruption of navicular architecture, decreased articular cartilage in coffin and pastern joints) diagnosed via MRI.

    My vet (20 yrs + experience orthopedic surgeon and tenured vet school professor) prefers to do a regional profusion of 1 vial Tildren, repeated 3x at 2 week intervals, logic being that 3 doses administered directly to the site of the injury is better than 10 doses administered to the whole body (systemic approach). In my horses case, we're treating both forelimbs, so he's getting a total of 6 doses.

    The other advantage of the regional profusion is that it does not leave the horse feeling colicy, like the systemic approach has been noted to do.

    In our case, this is a last-ditch effort to improve my horse's soundness but, according to the vet, Tildren poses virtually no adverse risk (to the horse that is - my finances on the other hand took a beating).

    The vet's opinion was however guarded as to whether or not Tildren would help my horse, who was very lame (despite excellent therapeutic shoeing, navicular bursa injections, and daily NSAIDs) when we began the treatment.

    That said, I went into this experience not expecting anything and was absolutely thrilled when my horse showed an immediate and marked improvement. Even the vet was surprised, who texted me after round two to say he was "super impressed".

    Round three was Friday and we'll wait a few more weeks before doing another lameness exam but so far I'd say it's been well worth the effort.

    The cost has been significant - $400/treatment ($200/limb) x 3, plus transportation to the vet x 3 - but to my mind well worth the shot at restoring some degree of soundness to my otherwise unresponsive-to-treatment and not-a-good-neurectomy-candidate horse.

    My horse also has lesions on his DDFTs (old/chronic in one foot, acute in the other - see "not-a-good-neurectomy-candidate" above) so, depending on how he is at re-check, we may follow up the Tildren with a round of PRP.



  20. #20
    Join Date
    Jul. 10, 2001
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    6,723

    Default

    Quote Originally Posted by byrtness View Post
    My horse received 2 tildren treatments via the large dose IV, one month apart approximately 5 years ago for some osteolysis in his hocks. It did seem to help him and he reached Grand Prix dressage. 4 months ago, at 18 years old, my horse broke his pelvis (complete fracture and displacement of tuber coxae, about 3-4 inches in from end, as well as another smaller fracture on the concave part of ilial wing). I found him like this in his stall in the morning, no sign of struggle or distress. He is a large horse, but it seems like this sort of injury would have needed a huge amount of trauma to cause it. In reading more and more about how Fosamax causes spontaneous fractures in humans, I'm afraid that the Tildren may have had something to do with my horse's injury?????? Any thoughts on this?
    My special horse now has to be retired from dressage due to this horrible injury.

    Very possible. Recent studies are finding that the use of bisphosphonates can induce strange severe fractures in people (most likely due to the destruction of the bone remodeling process). Yes, bisphosphonates can increase bone thickness by killing the bone resorbing cells but then the microdamage will accumulate leading to fracture (even in what appears to be healthy bone in an x-ray).

    A woman fractured her femur simply balancing on the subway. This was tracked back to the use of bisphosphonates.

    While these cases are relatively rare, they happen and it would not surprise me that we will see an increase of strange fractures in horses.

    Reed



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