Developmental Orthopedic Disorders and Arthritis

1. Developmental Orthopedic Disorders and Arthritis By: Holly Mozdin VT236-PL6

2. Developmental Orthopedic Disorders • Developmental Orthopedic Disorders aka “DOD” involves a diverse group of musculoskeletal disorders that occur in growing animals, most commonly fast-growing large-and-giant breed dogs. • DOD can be attributed to genetic make-up, nutritional and stress-related etiologies.

3. Developmental Orthopedic Disorders • Examples of DOD: • Canine Hip Dysplasia (CHD) • Dyschondroplasia (DCP) • Physitis (Physeal Dysplasia or Epiphysitis) • Angular Limb Deformities • Vertebral Abnormalities (Wobbler Syndrome)

4. Developmental Orthopedic Disorders and Nutrition • The skeletal system is most susceptible to physical and metabolic insult during the first 12 months of life because of heightened metabolic activities • Problems associated with dietary excesses are more likely especially in dogs fed a high-quality growth food that is further supplemented with minerals, vitamins and energy.

5. Developmental Orthopedic Disorders and Nutrition • Nutritional aims are as follows: • Feed a complete/balanced diet that does not precipitate any predisposition to DOD • When DOD do occur, the diet needs to limit any further damage that could be induced through poor or inadequate nutrition

6. Developmental Orthopedic Disorders and Nutrition • Fats • Excessive dietary energy intake may support a growth rate that is too fast for correct skeletal development • Dietary fat is the primary contributor to excess energy intake • Levels should be monitored in large-breed diets, due to fats having twice the calorific density of proteins and carbohydrates • Excessive energy intake can occur easily in diets with higher fat levels

7. Developmental Orthopedic Disorders and Nutrition • Fats continued • Dietary energy in excess of the animal’s needs will be stored as body fat • The role of body condition score (BCS) is important to monitor energy intake • Diets aimed at large and giant breeds have a decreased energy density in comparison to small-and-medium breed puppy diets.

8. Developmental Orthopedic Disorders and Nutrition • Protein • Diets aimed at fast-growing animals have higher protein levels • Should be of high quality and easily digestible • In dogs, protein excess has not shown to negatively affect calcium metabolism or skeletal development • A growth diet for dogs should contain >22% protein (dry matter base (DMB) of a high biological value

9. Developmental Orthopedic Disorders and Nutrition • Carbohydrates • Carbohydrate content of the diet needs to be balanced • Levels need to be sufficient to provide adequate calories to the animal, but not excessive to encourage excess weight gain • The type of carbohydrate within the diet is important • In cats and dogs, the carbohydrate content needs to be of highly digestible nature, especially in small breeds of dogs and kittens

10. Developmental Orthopedic Disorders and Nutrition • Carbohydrates continued • Carbohydrates need to be low in fiber • In kittens and small-breed puppies high levels of fiber would decrease digestibility of the diet, and due to limited stomach size, they would not be able to consume the quantities of calories required for growth

11. Developmental Orthopedic Disorders and Nutrition • Vitamins and Minerals • The level of calcium within the diet is vitally important in the development of orthopedic disorders in large-breed dogs • Equally so is the ratio of calcium to phosphorus present within the diet • Vitamin A is an essential factor in bone metabolism, especially orthoclastic activity • Vitamin D’s metabolites aid in the regulation of calcium metabolism and skeletal development

12. Feeding Animals with DOD • The feeding of an animal with or predisposed to DOD must be done on an individual basis, as growth rates and requirements differ greatly • Physical evaluation or BCS should be performed at least every 2 weeks • Care must be given when trying to avoid developmental problems by changing to an adult maintenance diet from a puppy diet, in order to avoid excess calcium and energy levels • Maintenance foods have a lower energy density than growth diets, so the puppy must consume greater amounts of the diet to reach its energy requirements

13. Arthritis • Osteoarthritis (OA) can be an exceptionally painful and crippling disease • OA is a chronic progressive disease characterized by pathological changes of the movable joints • Dietary manipulation can aid in the management of arthritis, and help improve an animal’s mobility • Arthritis can be divided into two types: • 1. Degenerative types of arthritis, in which the degradation of the articular cartilage is the prominent feature • 2. Inflammatory arthropathies, were synovitis is the main pathological feature

14. Arthritis • OA is the most common form of arthritis experienced in both animals and man • Management of OA includes: • Weight control • Appropriate exercise management • Anti-inflammatory medications • OA is characterized by degeneration of the articular cartilage and proliferation of new bone

15. Arthritis and Obesity • Obesity is a major risk factor of OA • Weight loss must be initiated ASAP • Exercising and consequently weight loss can be difficult due to restrictions in mobility • When deciding on a diet for an animal with OA, it needs to meet the requirements for the animal’s life stage and body condition score (BCS)

16. Arthritis and Supplements • The use of chondroprotectants and other nutraceuticals has become commonplace for cats and dogs with OA • Chondroprotective agents are reported to have three primary effects: • 1. Anabolic, by supporting or enhancing metabolism of chondrocytes and synoviocytes • 2. Catabolic, inhibiting degradative enzymes within the synovial fluid and cartilage matrix • 3. Antithrombolic, inhibiting the formation of thrombi in small vessels supplying the joint

17. Arthritis and Supplements • Nutraceuticals are a category of chondroprotective agents and are defined as non-drug substances that are produced in a purified or extracted form and administered orally to provide compounds required for normal body structure and function, with the intent of improving health and well-being • Examples of Nutraceuticals used in the management of OA are: • Eicosapentaenoic Acid (EPA), a Omega-3 (n-3) fatty acid that can help soothe the inflammation associated with OA • Glucosamine, when damage occurs to chondrocytes there is a decreased ability to synthesize glucosamine; supplementing the diet stimulates the production of preteoglycans and collagen by these cells

18. Diets • Purina Veterinary Diets • JM Joint Mobility® Canine Formula • Formulated to help improve mobility in arthritic dogs • long chain omega-3 fatty acids (including EPA and DHA (Docosahexaenoic Acids)), help with inflammation • Glucosamine, building block for cartilage repair • Antioxidants, that reduce enzymes involved in cartilage breakdown.

19. Diets • Iams Veterinary Diets • Joint/Canine • Nutritionally manages adult dogs with: OA, hip dysplasia, joint health concerns, and senior dogs • Glucosamine and Chondrotin Sulfate to provide building blocks for cartilage • Omega-6:Omega-3 fatty acid ratio targeting 5:1 to help nutritionally manage inflammation at the cellular level • L-Carnitine to burn fat to help maintain a healthy weight, which minimizes stress on joints • Optimal protein and fat levels to help maintain muscle mass and body condition

20. Diets • Royal Canin Veterinary Diet® • Canine Mobility Support JS™ 23 • Used for the nutritional treatment of OA • Green-Lipped Mussel (GLM) extract reduces the clinical signs of joint inflammation in dogs • EPA/DHA omega-3 fatty acids that modulate inflammation reactions • Supplemental levels of glucosamine and Chondrotin to help promote joint heath • Royal Canin Veterinary Diet® • Canine Mobility Support JS™ 24 Large Breed • Used for the nutritional treatment of OA in large breed dogs • Green-Lipped Mussel (GLM) extract reduces the clinical signs of joint inflammation in dogs • Supplemental levels of glucosamine and Chondrotin to help promote joint heath

21. Diets • Hills Prescription Diet® • j/d® Canine-Canned, j/d® Canine Mobility-Dry, j/d® Small Bites Canine- Dry • Recommended for OA • High levels of omega-3 fatty acids (EPA, ALA(Alpha-linolenic Acid)) to reduce inflammation and help inhibit the degradation of cartilage • Addition of Glucosamine and Chondrotin to provide building blocks for cartilage repair • Carnitine to help dogs burn fat while maintaining lean muscle mass • Clinically tested to reduce NSAID dosage by 25%

22. Diets • Hills Prescription Diet® • Recommendation • For obese dogs with Arthritis, feed Prescription Diet® r/d® Canine until ideal weight is achieved, then begin feeding j/d® Canine • Options • Up to 10% of the daily energy needs can be met by feeding Prescription Diet® Canine Treats while still maintaining appropriate nutrient profile to aid in the management of the underlying disease

23. Key Points • DOD • Ensure a correct calcium to phosphorus ratio • Feed a controlled energy level, suitable for the individual • Regularly assess weight and BCS • Use of a growth chart is advisable in the monitoring of growth rates • OA • Maintain optimal weight • Increase the use of antioxidants in order to reduce the amount of free radicals • Encourage the use of nutraceuticals as supplement or as part of dietary therapy • Ensure mobility is maintained, and the pain levels are under control

24. The End… • Resources: • Companion Animal Nutrition: A manual for Vet Nurses and Technicians • Purinavets.com • Us.iams.com • Royalcanin.us • Hillsvet.com