Distal tarsal joints osteoarthritis: Evidence behind bisphosphonates and NSAIDs to improve lameness



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PICO question

In lame horses affected by osteoarthritis of the distal tarsal joints (bone spavin), are bisphosphonates more effective than NSAIDs in long-term alleviation of lameness?


Clinical bottom line

Category of research question


The number and type of study designs reviewed

Two papers were critically reviewed. There was one field study and a multicentric randomised double-blind placebo control study

Strength of evidence


Outcomes reported

Each study looked at the effect of either Tiludronate or Firocoxib on alleviation of tarsal lameness. Both Tiludronate and Firocoxib, while administered independently, provided some degree of relief (for up to 120 days) and improved the lameness related to tarsal osteoarthritis


Since no study was found to directly compare the use of non-steroidal anti-inflammatory drugs and bisphosphonates and that none evaluate the long-term effects of these treatment options on lameness, it is not possible to recommend one treatment option over the other to alleviate lameness caused by tarsal osteoarthritis in horses


How to apply this evidence in practice

The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.

Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.


Open Access Peer Reviewed


Denoix, J.M., Thibaud, D. & Riccio, B. Tiludronate as a new therapeutic agent in the treatment of navicular disease: a double‐blind placebo‐controlled clinical trial. Equine Veterinary Journal. 2003; 35(4): 407–13. DOI: https://doi.org/10.2746/042516403776014226

Dyson, S. Are There any Advances in the Treatment of Distal Hock Joint Pain? Proceedings International Symposium on Diseases of the Icelandic Horse, 2004.

Dyson S.J., Murray R. & Schramme M.C. Lameness associated wth foot pain: results of magnetic resonance imaging in 199 horses (January 2001–December 2003) and response to treatment. Equine Veterinary Journal. 2005; 37: 113–121. DOI: https://doi.org/10.2746/0425164054223804

Gough, M.R., Thibaud, D. & Smith, R.K. Tiludronate infusion in the treatment of bone spavin: a double blind placebo-controlled trial. Equine Veterinary Journal. 2010; 42(5): 381–7. DOI: https://doi.org/10.1111/j.2042-3306.2010.00120.x

Kamm, L., McIlwraith, W. & Kawcak, C. A review of the efficacy of tiludronate in the horse. Journal of Equine Veterinary Science. 2008; 28(4): 209–14. DOI: https://doi.org/10.1016/j.jevs.2008.02.007

Riccio, B., Thibaud, D. & Denoix, J.M. A double-blind placebo-controlled trial of tiludronate in the treatment of bone spavin. BEVA Congress; 2002.

Doucet, M.Y., Bertone, A.L., Hendrickson, D., Hughes, F., Macallister, C., McClure, S., Reinemeyer, C., Rossier, Y., Sifferman, R., Vrins, Andre A., White, G., Kunkle, B., Alva, R., Romano, D. & Hanson, P.D. Comparison of efficacy and safety of paste formulations of firocoxib and phenylbutazone in horses with naturally occurring osteoarthritis. Journal of the American Veterinary Medical Association. 2008; 232(1): 91–7. DOI: https://doi.org/10.2460/javma.232.1.91

Orsini, J.A., Ryan, W.G., Carithers, D.S. & Boston, R.C. Evaluation of oral administration of firocoxib for the management of musculoskeletal pain and lameness associated with osteoarthritis in horses. American Journal of Veterinary Research. 2012; 73(5): 664–71. DOI: https://doi.org/10.2460/ajvr.73.5.664

Mitchell, A., Wright, G., Sampson, S.N., Martin, M., Cummings, K., Gaddy, D. & Watts, A.E. Clodronate improves lameness in horses without changing bone turnover markers. Equine Veterinary Journal. 2019; 51: 356–63. DOI: https://doi.org/10.1111/evj.13011

Whitield, C.T., Schoonover, M.J., Holbrook, T.C., Payton, M.E. & Sippel, K.M. Quantitative assessment of two methods of tiludronate administration for the treatment of lameness caused by navicular syndrome in horses. American Journal of Veterinary Research. 2016; 77(2): 167–73. DOI: https://doi.org/10.2460/ajvr.77.2.167

Schoonover, M.J., Whitield, C.T., Young, J.M., Sippel, K.M. & Payton, M.E. Quantitative assessment of intravenous regional limb perfusion of tiludronate as an adjunctive treatment for lameness caused by navicular syndrome in horses. American Journal of Veterinary Research. 2018; 79(12): 1313–1320. DOI: https://doi.org/10.2460/ajvr.79.12.1313





Vol. 5 No. 1 (2020): The first issue of 2020

Section: Knowledge Summaries

Categories :  Small Animal  /  Dogs  /  Cats  /  Rabbits  /  Production Animal  /  Cattle  /  Sheep  /  Pig  /  Equine  /  Exotics  /