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

Abstract

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 
 Treatment
 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 
 Weak
 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.
 Conclusion
 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.
 

Equine Musculoskeletal Pathologies: Clinical Approaches and Therapeutical Perspectives—A Review

“…In bone spavin medical treatment, tiludronate, in association with a controlled exercise program, reduces the lameness score and improves radiological images [140][141][142].…”