Are bisphosphonates a more effective treatment than intra-articular steroids in horses with distal hock osteoarthritis?

  • Hannah Greene Washington State University College of Veterinary Medicine Bustad Hall Pullman, WA 99163



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PICO question

In horses that are lame due to osteoarthritis of the distal tarsal joints (bone spavin), is intra-articular medication with corticosteroids compared to systemic bisphosphonate treatment more effective in long-term lameness reduction?


Clinical bottom line

Category of research question


The number and type of study designs reviewed

Three papers were critically reviewed. Two were randomised controlled trials, and one was a retrospective study.

Strength of evidence


Outcomes reported

There is insufficient evidence to support the use of systemic bisphosphonates over intra-articular corticosteroids to treat distal hock osteoarthritis in horses.


Horses with distal hock osteoarthritis should not be treated with systemic bisphosphonates until further blinded randomised controlled trials are completed. Additionally, supportive evidence for the use of intra-articular corticosteroids as a treatment for degenerative hock osteoarthritis is limited to a retrospective study where modest, short-term improvements are reported: 58% of horses improved after an average of 56 days (Labens et al., 2007). Evidence does not support significant improvement in long-term outcomes: 50% of horses improved after 4 months (Watts et al., 2016) and only 38% of horses improved after a mean follow-up period of 787 days (Labens et al., 2007).


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


Dyson, S. & Romero, J. (1993). An investigation of injection techniques for local analgesia of the equine distal tarsus and proximal metatarsus. Equine Veterinary Journal. 25(1), 30—35. DOI:

Dyson, S. (1994). Proximal suspensory desmitis in the hindlimb: 42 cases. British Veterinary Journal. 150(3), 279—291. DOI:

De Grauw, J., Visser-Meijer, M., Lashley, F., Meeus, P. and van Weeren, P. (2016). Intra-articular treatment with triamcinolone compared with triamcinolone with hyaluronate: A randomized open-label multicenter clinical trial in 80 lame horses. Equine Veterinary Journal. 48(2016), 152—158. DOI:

Gough, M., Thibaud, D. and Smith, R. (2010). Tiludronate infusion in the treatment of bone spavin: a double blind placebo-controlled trial. Equine Veterinary Journal. 42(5), 381—387. DOI:

Hoaglund, E., Selberg, K., Seabaugh, K., Hess, A. and Bass, L. (2019). Comparing the clinical success rate of the dorsolateral approach to the medial approach for injection of the centrodistal joint in the horse. Equine Veterinary Journal. Electronic version March 10, 2019. DOI:

Labens, R., Mellor, D. & Voûte, L. (2007). Retrospective study of the effect of intra-articular treatment of osteoarthritis of the distal tarsal joints in 51 horses. Veterinary Record. 161(18), 611—616. DOI:

Lamas, L., Edmonds, J., Hodge, W., Zamora-Vera, L., Burford, J., Coomer, R. & Munroe, G. (2012). Use of ethanol in the treatment of distal tarsal joint osteoarthritis: 24 cases. Equine Veterinary Journal. 44(4), 399—403. DOI:

Seabaugh, K., Selberg, K., Mueller, P., Eggleston, R., Peroni, J., Claunch, K., Markwell, J. & Baxter, G. (2017). Clinical study evaluating the accuracy of injecting the distal tarsal joints in the horse. Equine Veterinary Journal. 49(5), 668—672. DOI:

Watts, A., Dabareiner, R., Marsh, C., Carter, G. & Cummings, K. (2016). A randomized, controlled trial of the effects of resveratrol administration in performance horses with lameness localized to the distal tarsal joints. Journal of the American Veterinary Medical Association. 249(6) 650—659. DOI:

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  /