New options for navicular treatment
The recent approval of two new drugs that target the bone changes associated with navicular syndrome offers hope in some of the most frustrating cases.
The recent approval of two new drugs that target the bone changes associated with navicular syndrome offers hope in some of the most frustrating cases.
Just a few short years ago, owners of horses diagnosed with navicular syndrome had very few options. An infuriatingly vague diagnosis, the term “navicular” was often applied to cases of otherwise unexplained heel pain. Therapeutic trimming and shoeing could help preserve soundness for a few years, as could non-steroidal antiinflammatory drugs (NSAIDs), but there was no way to head off the inevitable: early retirement for the horse and heartache for the owner.
Then the navicular landscape shifted dramatically. Advances in MRI technology led to more precise identification of injuries and abnormalities in the heel area. A case that may have been chalked up to “navicular” even five years ago might now be revealed as an imparligament strain that is manageable by specific, focused treatments. The ability to see all structures in the back of the hoof transformed the veterinary profession’s understanding of what navicular was and wasn’t. With better diagnostics, options for treatments to manage heel pain, especially when caused by softtissue changes, suddenly multiplied.
But mysteries and frustrations remain. Horses who exhibit heel pain with no obvious soft tissue or cartilage damage are still tough cases. Lesions on the navicular bone, as well as bone edema (bruising), are often found in lame horses, but they are also seen in plenty of horses who are perfectly sound. The relevance of “abnormal” looking navicular bones is still unclear. And treatments to address navicular lameness related to bone changes were still limited to corrective shoeing and anti-inflammatory medications. That is, until very recently.
In the summer of 2014, the navicular landscape made a sudden shift again. That’s when the Food and Drug Administration (FDA) approved two new medications for the treatment of navicular syndrome, specifically targeting bony changes seen in many cases. Both drugs, sold under the names Tildren and Osphos, belong to a medication class known as bisphosphonates. Both have similar action, and both are prescribed with the same intentions. But they aren’t identical. This means that horse owners coping with bone-based navicular problems have, for the first time in a long time, options.
Tildren and Osphos are available only by prescription, and a veterinarian will need to determine if one or the other may help treat a particular bone problem. But if you’re caring for a horse with navicular syndrome, you’ll want to have a conversation with your veterinarian about the role bisphosphonates might play in your long-term management plan. Here’s what you need to know to start that discussion.