Is an obscure osteoporosis drug a ticking time bomb for horse racing?

Horse racing fatalities in Kentucky increase significantly

Statistics on Kentucky horse racing fatalities in 2018.
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Statistics on Kentucky horse racing fatalities in 2018.

This year, horse racing made national news for the horrific and mysterious deaths of at least 23 horses in three months at Santa Anita Park in California. What almost nobody noticed was that last year Kentucky had a similar problem.

Horse fatalities at Kentucky’s tracks nearly doubled in 2018.

At the February meeting of the Kentucky Horse Racing Commission, equine medical director Dr. Mary Scollay outlined the problem: Fatalities went from 20 in 2017 to 36 in 2018, an 80 percent increase. The rate of fatalities rose as well, from 1.33 per 1,000 starts to 2.39, she said.

Kentucky hasn’t reported fatality rates like that in the 13 years that the state has tracked them, according to racing commission data.

“It’s unprecedented,” she said.

In fact, the problem in Kentucky might actually be far worse: Unlike Santa Anita’s numbers, Kentucky’s do not include horse fatalities during or as a result of training because the Kentucky racing commission only counts racing fatalities.

Even so, the change was dramatic: The deaths were across all Kentucky tracks, as were the increases, according to Scollay.

She has no clear answer as to why there were more horse deaths but she noted one shift: The horses that died were younger.

Data on horse fatalities, in Kentucky and across the country, for years has established the riskiest age for a racehorse as 3 to 4 years old. But last year’s Kentucky deaths were more likely to be 2- and 3-year-old horses, Scollay said in an interview.

“It made me wonder if something had changed in the horse population,” Scollay said. “Because I knew we hadn’t changed our pre-race vet checks or protocols,” which are designed to catch horses that shouldn’t be racing before they go out to the starting gate.

Somehow, those horses were getting through.

A ticking time bomb

Scollay, like many others in horse racing, wonders if a relatively new class of drugs could be masking vulnerability in bones (and the deaths in Kentucky and in California are almost all musculoskeletal) that is contributing to the wave of deaths.

Bisphosphonates are osteoporosis medications approved about five years ago for use in horses 4 or older to treat a bone disease called navicular. They work not by building new bone but by killing off the cells, called osteoclasts, that clear away bone with microdamage. In people with serious disorders such as osteoporosis, this helps because it prevents the hollowing of bones.

But vets can prescribe it legally for other bone problems in younger horses, including soreness.

Concerns about using the drugs in racing have been building for years.

Ed Martin, president and CEO of the Association of Racing Commissioners International, said that his organization, which lobbies for regulatory change, called for the regulation of breeding and sales more than a year ago, expressly with concerns about bisphosphonates.” And it was only until fairly recently that people started to move on that,” Martin said. “We’re very concerned about whether they are safe to be given to young horses … We’re concerned about the science that shows when it is given to young mammals it can cause stress fractures. We don’t have equine-specific research … but other research shows its connection to stress fractures and the link to catastrophic injury.”

Last April, two vets presented concerns to the ARCI annual meeting about widespread off-label usage of these drugs in racehorses and young horses. Dr. Sue Stover of the University of California-Davis veterinary college said that bisphosphonates had been regarded as “a silver bullet” for myriad bone issues.

Instead that might have created what has been called a ticking time bomb in some racehorses. The drugs are suspected of creating bones that look sound on X-rays but aren’t capable of normal healing.

Renowned equine orthopedic surgeon Dr. Larry Bramlage of Rood & Riddle said that when the drugs, sold under the name Tildren and Osphos, first became available, he was concerned they would create the potential for catastrophic breakdowns. Instead, what he began to see was horses taking months longer to heal from routine injuries.

“I have no doubt that is the case,” Bramlage said last week.

He thinks that a ban on the use of bisphosphonates in young horses is a smart move but is skeptical the drugs are responsible for the rash of breakdowns that racing has seen.

And indeed no one has conclusively connected bisphosphonates to a single fatal breakdown in Kentucky, California or elsewhere.

“I do not think that if you give bisphosphonates to a horse that is 12 or 14 months of age that if the horse has an injury at 3 it’s a direct result of bisphosphonates,” Bramlage said. “They’re slow leaving the system … But is it the cause of breakdowns at 3 or 4? I doubt it.”

But the use in horses in training has come under new scrutiny.

In December, at the request of the horse auction houses, the American Association of Equine Practitioners looked at the drugs. The conclusion: The off-label use of bisphosphonates in racehorses is “akin to Russian roulette.”

Dechra Veterinary Products, the maker of Osphos, said that the company is “committed to the health and welfare of the horse, first and foremost,” in a statement from Dr. Jill Stohs, director of pharmacovigilance and veterinary services. “The use of Osphos for the purpose of augmenting radiographic films has not been substantiated by science. Dechra considers this to be an unwarranted use of the product and find it misleading,” Stohs said.

Bimeda, now the maker of Tildren, did not immediately respond to a request for comment but the company’s website cautions “the safe use of Tildren has not been evaluated in horses less than 4 years of age.”

Banned by sales

There is no data about how long the drugs stay in a horse’s system or how long the changes in bone growth take to reverse.

Scollay and others say they have heard that horses being prepped for sales, particularly 2-year-old sales, are treated to improve the look of certain bones on radiographs, in part to give buyers more confidence in a horse in training.

That’s why Keeneland, Fasig-Tipton and the Ocala Breeders’ Sales on March 25 announced what they called a ban of the “off-label use of bisphosphonates.” The sales companies, which collectively auction thousands of yearlings, 2-year-olds in training and racehorse prospects, will let buyers request that horses be tested for the drugs. If a horse tests positive, the sales companies say, “a buyer has the right, within 24 hours of notification, to rescind the sale.”

“This is an integrity issue,” the companies said in a joint statement. “We all agree that this policy is critical to strengthen buyer confidence in the entire Thoroughbred auction process.”

Bob Elliston, vice president of racing and sales for Keeneland, said that he also has heard vets have given the drugs to alter the appearance of bones on radiographs, which are a crucial tool for potential horse buyers who might spend millions on Thoroughbred yearlings.

“We don’t believe that should be permitted,” he said. “What we’re doing is a part of the policing. There are other parts that need to be addressed.”

Carrie Brogden, co-owner of Paris Thoroughbred farm Machmer Hall and breeder of champion Tepin, said that breeders got a “heavy press” when the drugs came out but she and many others balked at the price tag of “upwards of $500 a dose.” She estimates that maybe 5 percent of farms have used it.

She said that those who did use it didn’t necessarily use the drugs for improper purposes.

She recalls pinhookers (people who buy young horses to train and resell) in Florida recommending Osphos. “They were telling me how much better the horses were feeling,” Brodgen said. “I don’t think we realized the repercussions. I think they thought they were doing right by their horses.”

Some Thoroughbred consignors also have taken to Twitter to pledge that the horses they offer for sale are untreated. Mark Taylor of Taylor Made Sales, one of the biggest, posted: “We have never used this drug on our young horses and we pledge to continue that policy.” Denali Stud and Siena Farm tweeted similar pledges.

Taylor said on Friday that he thinks that use of the drugs has been limited and probably was done with good intentions.

“I, frankly had never really heard of this drug until about a year and a half ago,” Taylor said. A client told him that a racehorse sent to Bramlage hadn’t healed and that the vet thought it might have been on bisphosphonates.

“My gut feeling is that it’s not something that was just epidemic through a huge percentage of the September sale, which is the hub of the market. I think it was a very low percentage of horses treated with it, because it was mainly horses with serious sesamoiditis,” Taylor said. Sesamoiditis is a painful inflammation that can cause lameness that can require months of convalescence.

And he said that “if our vets had come to us and said it could help with sesamoiditis, I probably would have said, ‘great.’ We would have done the same thing.”

Now that the dangers are becoming known, he said, the industry is doing the right thing to restrict bisphosphonate use.

Suddenly, bisphosphonates were on everyone’s to-do list.

On March 26, racehorse organizations in the Mid-Atlantic coalition, which includes Delaware, Maryland, New Jersey, New York, Pennsylvania and West Virginia, announced an “immediate and strict prohibition” on the use of bisphosphonates in horses under the age of 4.

On March 28, The Jockey Club called for a set of sweeping reforms that include reporting of all injuries in training and racing and complete transparency in veterinary records and endorsing the Horseracing Integrity Act introduced last month by U.S. Rep. Andy Barr, R-Lexington and U.S. Rep. Paul Tonko, D-N.Y. Barr on Wednesday joined calls for a congressional hearing into the horse deaths.

Proposals put forth by The Stronach Group, which owns Santa Anita, Gulfstream Park and Pimlico, “follow a pattern that has been familiar in horse racing for decades: as an industry, we are more often than not reactive to our problems, and changes are slow, sporadically implemented, and often ineffective. From past scandals involving steroids to dermorphin to cobalt to the most recent matter implicating the potential use of bisphosphonates in inappropriate methods, we lag behind cheaters and abusers and by the time we have caught up they have moved on to the next designer substance,” The Jockey Club said in the paper.

And on April 4, the RCI’s model rules committee will consider prohibiting young horses from racing if they have been given bisphosphonates, similar to what the British Horseracing Authority has done.

“Until such a time we know these drugs are safe, and there is certainly enough concern among regulatory vets that they are not, we need to find a way to phase these out of horse racing,” Martin said.

But can they catch it?

The problem is that there is almost no way to enforce these bans without much greater regulatory control of the entire industry.

While bisphosphonates can be detected pretty easily for a month, and possibly up to three months with a blood test, Scollay and others said it has been difficult to detect after the drug adheres to bone.

Dr. Mary Scollay, who became Kentucky’s Equine Medical Director in 2008, said she has more questions than answers about the increase in fatalities in Kentucky.

She said that bone chips of horses who broke down on Kentucky tracks last year were tested but the drug was not detected. However, the testing lab also wasn’t able to detect it in a control group of horses who had been given bisphosphonates, she said.

“There is an unquantifiable concern about the potential use of bisphosphonates in sales,” she said. “These horses can change hands several times before they end up at the track … There’s a disconnect at the moment that can’t be resolved.”

Yearlings being prepped for the September sales might be getting drugs now, she said, and the tests currently in use would not be able to find them.

That leaves Kentucky still with a lot of questions unanswered, she said, about whether bisphosphonates are part of the problem.

‘More than a little nervous’

Vets have another concern: The medication is a painkiller.

Fatal breakdowns often are the result of cumulative injuries that aren’t fully healed. Take away the pain and you take away the body’s warning signal.

Add in a drug that alters bone growth “and that makes me more than a little nervous,” Scollay said. “Say you’ve got a 2-year-old in training who’s just weird … You can’t spot what’s wrong but he’s just not right. … So you give bisphosphonates for the analgesic effect and you’ve potentially made him more vulnerable for fracture.”

It seems like “it could be a double whammy,” Scollay said.

Stohs, the spokesperson for the maker of Osphos, said that the pain-relieving effect of bisphosphonates has not been studied in the horse but the drug class has been shown to produce “temporary relief of pain in humans ... Dechra does not recommend Osphos be administered for the sole purpose of short-term relief of pain.”

Going into the opening of the Keeneland spring race meet and crucial Kentucky Derby prep races, Scollay said she will be watching closely.

“I am concerned at all times anyway. We do our best, we keep looking for ways to do better and at the end of the day, I still have concerns,” she said. “We’ve had a good start to the year so far at Turfway but we’ve got a long way to go to say we’re doing better.”

Kentucky Sen. Damon Thayer, who has served on Kentucky’s Equine Drug Research Council for 14 years, said he plans to suggest Kentucky look at bisphosphonates, too.

“Kentucky used to be considered the wild, wild West on medication but through multiple (gubernatorial) administrations, I think Kentucky has led the way on a lot of these reforms,” Thayer said. “We have taken strong steps … to protect the safety of equine athletes, and jockeys and exercise riders. And I think our racetracks do a great job of implementing racing standards. But we have to remain vigilant and at the forefront.”