Friday, April 11, 2008

Tildren-comments and more questions

I have had quite a few responses to a post on "Gallium Nitrate and Tildren". The main point of my post was the pushing of Gallium nitrate on the public as a scientific treatment for navicular disease, which still has no scientific backing today. This one came in recently. "Isn't the primary effect of Tildren to inhibit bone resorption? A related effect would be, yes, to reduce the Calcium in the blood, if this were coming from excess bone remodelling. It's not to treat the blood Calcium , but to reduce damage to the bone...which increases blood Calcium. I'm absolutely sure you know this already, but your comment is leading and misleading. You must be a fan of Richard Dawkins". I'll try to address those questions here. Tildren (tiludronate) was also mentioned as a recent treatment for Navicular disease (also tarsal arthritis and thoracolumbar pain ) American Journal of Veterinary Research, March 2007, Vol. 68, No. 3, Pages 329-337. Tildren is a drug developed to treat hypercalcemia associated with certain malignancies. This is caused by production of substances that mimic parathyroid hormone and causes activation of osteoclasts and excessive bone resorption. Since in some cases of Navicular disease there is significant bone damage, it is postulated that Tildren can reduce the osteoclastic activity and prevent this change. In the limited number of studies done thus far it is difficult to rationalize the results seen. In a group treated for thoracolumabar pain (15 tildren/14 placebo) there was an improvement noted 60 days later in the treated group. What is the original inciting injury in these cases? (The same question applies to navicular disease) . If there is a lesion present before the study why does preventing further bone resorption eliminate the original source of pain or are they saying that excessive osteoclastic activity is the primary disease entity in these cases. I recently spoke with a surgeon that co-authored one of the papers on the use of Tildren and it was his opinion that in cases where the MRI showed a fluid signal in the navicular bone ie. bone loss, then they used Tildren and thought there was clinical improvement. I can't dispute his findings and he is a top drawer surgeon, so I have to go with his opinion. However, I still scientifically question if there are other effects from this drug causing the relief seen in these cases. Is it just that by stopping further bone loss ,the inciting causes are reversed. How does this address the soft tissue changes, flexor tendon lesions, coffin joint synovitis, impar ligament changes and conformational issues frequently seen with navicular disease. Does Tildren have some anti-inflammatory or pain relieving properties. There have been many drugs and treatments proposed for Navicular disease/syndrome over the years , many never stood up under the light of scientific scrutiny. Tildren may prove to be a very effective treatment and then again it may not. I think the light still needs to be shown on it a little more.
So where do I stand.....Gallium is still a hoax, Tildren may be helpful ( if you have a Board Certified Specialist tell you so) and I had no idea who Richard Dawkins was until this email ( not much in common there)


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Anonymous said...

what about tildren for the treatment of severe arthritic hock changes in an upper level event horse? and are there any problems associated with the use of tildren in conjunction with hock injections? please please advise, thanks so much. jw from upperoc, md.