Osphos

Introduction

As an equine veterinarian you will be evaluating lameness cases every day.

Some of these can be a real challenge to treat. Having a variety of appropriate treatment options at your disposal is of utmost importance to satisfy your clients’ needs and keep their horses performing.

Osphos has revolutionised the way the bone disease of navicular syndrome can be treated. Learn more about Osphos and the experiences of your veterinary colleagues in the following.

Equine Expert Panel

Write a short introduction about the Expert Panel here.

How does Osphos improve lameness without changing systemic bone turnover markers?

Ashlee Watts. PhD, DVM, DACVS. Assistant Professor, Equine Orthopedics. Texas A&M University.
(Mitchell et al. 2019)

Can I, and when should I re-dose Osphos?

Marc Koene, DVM. Equine Practitioner, Orthopedics & Sports Medicine. Tierklinik Lüsche

What is the safety margin of Osphos?

Chris Kawcak, PhD, DVM, DACVS, DACVSMR. Professor, Orthopedics & Equine Sports Medicine. Colorado State University.

How do I use Osphos as part of a multimodal approach?

Richard Markell. DVM, MRCVS, MBA. Ranch & Coast Equine Practice, IlluminX consulting

On 14^th May 2019 a meeting on Clodronate Use in Horses was held in Denver, Colorado, organised by LifeLearn Animal Health. A range of experienced equine practitioners and lameness specialists were invited to discuss their experience of clinical use of Osphos in horses of all disciplines. They also discussed the latest clodronate research and how this research can be utilised by practitioners to gain maximum benefit from Osphos.

Reasons to choose Osphos

Osphos is the only veterinary approved bisphosphonate product that can be easily administered via the intramuscular route
Osphos is the only veterinary product that contains clodronate (clodronic acid), a non-nitrogenous bisphosphonate, as the active ingredient
Osphos provides clinical improvement lasting up to 6 months to horses with navicular bone disease after a single administration

Erase of administration

Osphos is easily administered via intramuscular injection.

The total injection volume should be divided between 2 - 3 injection sites.
Suitable sites for injection:
1. Centre of the lower neck
2. Pectoral muscles
3. Gluteal muscles
No need for repeated IV injection or for IV catheterisation, reduces risk of thrombophlebitis and makes treatment quick and easy.

Osphos solution for injection is presented in a 15 ml vial, sufficient to treat one horse.

Recommended dosage: 3 ml per 100 kg of bodyweight, with a maximum of 15 ml per horse.

Watch video: How Osphos is administered

Bisphosphonate classes and how this affects use

There are two distinct classes of bisphosphonates, each class has a different mechanism of action and different side effects. It is important for veterinarians to understand the differences.

Non-nitrogenous bisphosphonates	Nitrogenous bisphosphonates
Do not contain nitrogen in their molecular structure.	Have nitrogen incorporated in their molecular structure.
Clodronate and tiludronate belong to this class and are the only bisphosphonates that are approved for veterinary use and for which efficacy and safety data are available.	Include molecules such as zoledronate, alendronate, risedronate, etc. None of the nitrogenous bisphosphonates are approved for veterinary use.
Intracellular mode of action: primarily act via the formation of intracellular ATP analogues.	Intracellular mode of action: principal mode of action is via the intracellular mevalonate pathway.
Listed as Controlled Medications by the FEI, (International Federation for Equestrian Sports) which means they can be used in competition horses, provided an adequate withdrawal time is taken into consideration.	All nitrogenous bisphosphonates are listed as Banned Substances by quine sports organisations which means that they cannot be used AT ANY TIME.

Non-nitrogenous bisphosphonates
Do not contain nitrogen in their molecular structure.
Clodronate and tiludronate belong to this class and are the only bisphosphonates that are approved for veterinary use and for which efficacy and safety data are available.
Intracellular mode of action: primarily act via the formation of intracellular ATP analogues.
Listed as Controlled Medications by the FEI, (International Federation for Equestrian Sports) which means they can be used in competition horses, provided an adequate withdrawal time is taken into consideration.

Nitrogenous bisphosphonates
Have nitrogen incorporated in their molecular structure.
Include molecules such as zoledronate, alendronate, risedronate, etc. None of the nitrogenous bisphosphonates are approved for veterinary use.
Intracellular mode of action: principal mode of action is via the intracellular mevalonate pathway.
All nitrogenous bisphosphonates are listed as Banned Substances by quine sports organisations which means that they cannot be used AT ANY TIME.

Clodronate

As with other non-nitrogenous bisphosphonates, the primary action of clodronate is an anti-resorptive effect in bone. However there is some evidence that the clodronate molecule specifically may also possess other properties such as anti-inflammatory effects. (Markell et al. 2019). Osphos is not approved for use as an anti-inflammatory drug.

No specific detection time has yet been published by the FEI, whereas the BHA (British Horseracing Authority) has published a stand-down period of 30 days for both clodronate and tiludronate.

Efficacy

Clinical studies have demonstrated that horses with navicular syndrome respond positively to treatment with Osphos.

Frevel et al. Clodronate disodium for the treatment of clinical signs of navicular disease - a double-blinded placebo-controlled clinical trial. Pferdeheilkunde 2017;33:271-279.

75 % of horses had responded positively to Osphos treatment by day 56. This was highly statistically significant compared to the control group (p = 0.0028).
48% of the horses treated with Osphos were sound at day 56, compared to 0% of horses in the control group.
66% of horses treated with Osphos maintained the improvement in lameness for 6 months. Differences in lameness improvement at day 56 after treatment.

Other studies have confirmed the positive effect of Osphos for the treatment of bony conditions associated with navicular disease.

Mitchel et al. Clodronate improves lameneness in horses without changing bone turnover markers. Equine Vet J. 2019;51(3):356-363.
Stoiber et al. Therapeutic options for treatment of navicular bone disease with clodronic acid under practice conditions - a retrospective case series with 35 horses. Tierärztliche Umschau 2017;9:324-330.
Argüelles et al. Clinical efficacy of clodronic acid in horses diagnosed with navicular syndrome: A field study using objective and subjective lameness evaluation. Res Vet Sci 2019;125:298-304.

Safety

Side effects

Side effects recorded during the clinical field trial were mild and transient (Frevel et al. 2017)

For more information about incidence and type of adverse reactions please click here.

Watch video: Efficacy & side effects

Interactions with other medicinal products

Medications such as aminoglycosides, whose toxicity can be exacerbated by a reduction in serum calcium, and medications such as tetracyclines, that can reduce serum calcium, should not be given for 72 hours after administration of clodronic acid.
Concurrent administration of potentially nephrotoxic drugs, such as NSAIDs, should be approached with caution and renal function should be monitored.

For more information about warnings and interactions please click here.

Client Education

These videos will help you explain navicular syndrome and how Osphos works to your clients.

What is Navicular Syndrome?

How to diagnose Navicular Syndrome

Introducing Osphos

How Osphos works

How is Osphos administered?

Osphos efficacy & side effects

Support Materials

Sales aid/Brochure

Osphos SPC except only

Osphos Clinical Field Study Brochure

Testimonials

Osphos® - Fyrnwy Equine Clinics

Osphos® - Nantwich Veterinary Group Equine Centre

Osphos® - Tullyraine Equine Veterinary Clinic

Dr. Steve Colburn. Bisphosphonate: Next-level Navicular Treatment

Literature

Argüelles et al. 2019

References

Markell R., Saviola G., Barker E. A., Conway J. D., Dujardin C. (2019). What do we know about clodronate now? A medical and veterinary perspective. Journal of Equine Veterinary Science https://doi.org/10.1016/j.jevs.2019.102874 102874.
Frevel M., King B. L., Kolb D. S., Boswell R. P., Shoemaker R. S., Janicek J. C., Cole R.C., Poole H.M., Longhofer S. L. (2017). Clodronate disodium for treatment of clinical signs of navicular disease-a double-blinded placebo-controlled clinical trial. Pferdeheilkunde, 33, 271-279.
Stoiber J., Koene M., Mageed M., Swagemakers J. H. (2017). Therapeutic options for treatment of navicular bone disease with clodronic acid under practice conditions-a retrospective case series with 35 horses. Tierärztliche Umschau 72(9), 324-330.
Argüelles D., Saitua A., de Medina A. S., Muñoz J. A., Muñoz A. (2019). Clinical efficacy of clodronic acid in horses diagnosed with navicular syndrome: A field study using objective and subjective lameness evaluation. Research in Veterinary Science, 125, 298-304.
Mitchell A., Wright G., Sampson S. N., Martin M., Cummings K., Gaddy D., Watts A. E. (2019). Clodronate improves lameness in horses without changing bone turnover markers. Equine Veterinary Journal, 51(3), 356-363.

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Introduction

Equine Expert Panel