As medical managers of the horses, practitioners are encouraged to use clinical findings to guide their decision to re-dose clodronate.
Prognosis following treatment
The panelists have generally observed significant clinical success in using clodronate to treat heel-sore horses or other forms of bone pain, given appropriate selection of cases where there is apparent bone change. They acknowledged that, due to the complexity of comorbid conditions and the likelihood of reinjury, that redosing is a likely scenario in the months following the first dose.
The panelists emphasized that, for evaluating the efficacy of treatment, practitioners should focus on resolution of clinical signs and feedback from clients/trainers, rather than radiological evidence of improvement. They caution against labeling the horse as a chronic case, which can affect its value and the trainer’s perspective.
"If you just see the sclerosis and the resorption, that doesn't necessarily mean at that moment in time it's a clinically significant finding."
“I commonly will tell a client, "[Horses] don't run on their x-rays." That's pretty common to have a sound horse with what some would consider some pretty bad x-rays.”
Redosing and performance maintenance
The panelists were comfortable with the label recommendations for redosing clodronate in 3 to 6 months and emphasized that redosing should be based on clinical need. Horses should be re-evaluated in an appropriate time frame following the previous dose to assess if it is the same, recurrent problem that will be responsive to the same treatment, or if the horse’s condition has changed, a different approach is required.
"Horses are masters of compensation, so when they have a primary problem and they start to compensate, other things start hurting."
The panelists cautioned against the practice of prophylactic or maintenance medications that is prevalent in equine sports medicine. Practitioners should be mindful that the efficacy of clodronate might encourage clients and trainers to push for additional doses when it is not indicated. Although safe if used as indicated, the panelists encourage practitioners to be judicious with the use of clodronate, as with any other type of medication, and to re-evaluate the horse before proceeding with redosing.
"I think we need to be careful and thoughtful as really the medical managers of that horse to discourage just a routine redosing and I don't believe in pre-emptive or preventative medications."
Furthermore, practitioners should evaluate if the horse is a responder or non-responder to clodronate when considering redosing. If a horse has successfully been treated with clodronate in the past, it can become part of the horse’s maintenance strategy.
Price point and compliance
Along with the safety and efficacy, the affordable price point of clodronate has made it easy for the panelists to recommend to clients. For horses with recurring lameness issues, the addition of clodronate to an overall treatment regimen has enabled practitioners to reduce the number of other, more invasive procedures such as intra-articular joint injections. The panelists have reported high compliance when redosing is recommended because clients can see the clear benefits of clodronate in keeping their horses comfortable and able to work.
"A lot of these older horses, they're getting injected coffin joints, pasterns, hocks, sacroiliac; and so you constantly feel like you're putting your finger in the leaking hole in the boat. And that gets expensive. […] [Clodronate] really reduces that catch-up game that we're having to play. And you're spending quite a bit a lot less money too."