Preventive Measures in Canine Orthopaedic Medicine
World Small Animal Veterinary Association World Congress Proceedings, 2003
Åke Hedhammar, DECVIM
Professor Internal Medicine-Companion Animals Department of Small Animal Clinical Sciences, Swedish University of Agricultural Sciences
Uppsala, Sweden

Since the classical studies by Sir Edward Mellanby on vitamin D and Calcium, also other risk factors related to skeletal diseases in Dogs have been indicated by experimental as well as epidemiological studies. Preventive measures based on these studies are mainly advices on breeding and feeding. In a critical appraisal, risk factors (A) and generalised (B) as well as more specific (C) measures against skeletal diseases will be reviewed with reference to these studies.

A. Risk factors

1. Large size

Developmental and degenerative skeletal disorders are more common in large sized dogs (Bonnett et al. 1997, LaFond et al. 2002). When Sir Edward Mellanby between 1921 and 1944 published classical studies on the need for vitamin D, calcium and phosphorus for skeletal health in growing dogs, he also noticed that large sized dogs were more severely affected by Rickets and that those that ate less were less affected than those eating large amount of diets deficient in these nutrients (Mellanby 1944). Besides the need for specific nutrients it indicates how genetic factors for large size and rapid growth as well as feeding patterns promoting that, also influences incidence and severity of skeletal disorders.

Developmental Skeletal diseases like hip dysplasia and osteochondroses but also skeletal diseases like panosteitis and metaphyseal osteopathy do mainly affect large sized dogs. The greater risk in large sized dogs has been related to increased weight as well as increased height. For example the higher risk to get Osteosarcoma is closer related to height than to weight in both man and dogs (Ru et al. 1998).

Selecting a large sized dog either by breed or as an individual increases the risk of skeletal disease in general. Exception to this is congenital luxation of shoulders and elbows, craniomandibular osteopathy, Perthes Disease and medial patellar luxation mainly seen in smaller dogs.

2. Age

Developmental skeletal diseases are diagnosed to a great extent during growth but resulting degenerative processes also accelerates with age (Egenvall et al. 2000, Wood et al. 2003).

3. Breed

Breed predispositions to skeletal disease have been indicated in several case series as well as epidemiological studies based on hospital populations and national populations of dogs. Giant breeds and breeds like Bernese Mountain Dog and Rottweiler have increased risk of various skeletal disease whereas others have significantly greater risk to specific diseases as i.e., Boxer to develop metaphyseal osteopathy (LaFond et al. 2002). Part of the breed predisposition can be related to conformity like unproportional giant size--acromegaly--in giant breeds and unsuitable angulations of knees and hocks as in Chow-Chows.

4. Sex

Male dogs do encounter skeletal diseases to greater extent and worse than females (Egenvall et al. 2000). Selecting a male dogs within a breed or litter increases the risk of skeletal disease in general but in some breeds prevalence of hip displace is documented to be higher in females than in males (Swenson et al. 1997a).

5. Neutering

Neutered males as well as females are more prone to injuries to cruciate ligaments than intact males and females (Duval et al. 1999) and neutered dogs do develop osteosarcoma to greater extent than intact Dogs (Rue et al. 1998).

6. Rapid growth

Rate of growth is genetically determined to great extent with variations between as well as within breeds. To achieve large size at a rapid rate specific nutrients have to be furnished in large amounts. The most important factor though is the amount of energy furnished (Hedhammar et al. 1974).

7. Genetic influences

Although some causes of dwarfism have a simple recessive inheritance, and that it also has been indicated that osteochondrodysplasia and Perthes disease might be caused by a simple recessive inheritance, it is not common that skeletal disease are caused by variation in just one gene. Exceptions are skeletal manifestations of mucopolysaccharidoses (Campbell et al. 1997)and metaphyseal osteopathy in Irish Setters when caused by CLAD (Trowald-Wigh et al. 2000)

Most skeletal diseases have a polygenic inheritance, although major genes may exert stronger influences than other. Hip Dysplasia and Elbow Arthrosis resulting from Elbow Dysplasia regardless of its primary cause (osteochondrosis, FPRC, UPC) are example of entities that have shown heritability estimates between 0.2 and 0.6 (Swenson et al. 1997a,b).

8. Nutrition

Rickets defined as a deficiency in vitamin D and also deficiency of calcium is extremely rare conditions in small animal veterinary practice today. Nutritional Secondary Hyperparathyroidism can be seen in puppies fed all meat diets by its high phosphorus and low calcium content, but is rarely seen nowadays in affluent societies.

a. Overfeeding-to much food

Since we performed at Cornell University our studies on the effects of overnutrition on skeletal diseases in general in the early seventies (Hedhammar et al. 1974) several groups have used the same design to look at the effects of excessive amount of food during growth by allowing littermates ad lib feeding or just 75 % of that amount. Some of these studies have also been done on Great Danes and elucidated on the role of specific nutrients. Others have been on other breeds and in particular on the effects of overfeeding on the development of hip dysplasia (Kasström 1975,Kealy et al. 2000).

b. Oversupplementation--excessive amounts of specific nutrients

In our study at Cornell, by design, we used a diet with a high calcium content (2,1 %). During our study it became apparent that such a high calcium content add to the detrimental effects of overfeeding. It was postulated that excessive food--overfeeding as well as excessive amounts of calcium--oversupplementation with calcium is not compatible with optimal skeletal characteristics in large sized breeds. The Dutch research group in Utrecht have then proven that a too high calcium content in a diet have negative effects also when fed in more restricted amounts (Goedegebuure et al. 1986) and that negative effects are not caused by level of protein (Nap et al. 1991)

9. Exercise / Training

Very little is actually documented regarding effects of exercise and training methods applied unwisely on growing dogs with a vulnerable skeleton (Slater et al. 1992, Sallander et al. 2001). Heavy training programs, however, may result in changes, which predispose to development of osteoarthritis in dog as well as man (Arokoski et al. 1994). It is feasible to assume that physeal fractures and injuries to the cruciate ligaments, to some extent, can be related to training and exercise.

10. Exposure to Tick-borne infections

Among infectious agents involved in arthritis, Borrelioses and TBE (Tick-Borne Encephalitis) make tick exposure a risk factor to get arthritis. Hunting dogs and other working Dogs are more exposed to ticks and therefore at greater risk.

B. General preventive measures

1. Breeding

Selection of breeding stock is of utmost importance to decrease prevalence of most orthopaedic conditions except truly traumatic ones. Individuals affected by any orthopaedic condition if not truly of traumatic origin but including those with unknown aetiology are not suitable for breeding. When it comes to conditions like hip dysplasia and elbow arthrosis with formal screening programs, also information on relatives--parents, siblings and progeny already produced, should be considered. (Hedhammar et al. 1979, Hedhammar et al. 1999)

2. Feeding

Growing dogs should be fed complete and balanced diets. That is diets with neither to little or too much of any specific nutrients. In large sized dogs calcium level should neither be to high or to low and in balanced proportion to the level of phosphorus. Large sized dogs should be fed even complete and balanced diets in restricted amounts rather than ad-lib.

Nutraceuticals as glucosamine, chondroitin sulfate and polyunsaturated fatty acids have been evaluated for their chondro-protective and anti-inflammatory effects and were found to positively impact cartilage conditions. Further studies are needed to advice on their optimal usage as preventive measures.

3. Exercise /Training

Exercise and training of especially growing dogs should be performed with care.

C. Specific measures

1. Metaphyseal osteopathy (MOP)

Affected dogs should not be bred from. Usage of complete and balanced diets in restricted amount are the only preventive measures that can be instituted in this idiopathic condition and that is also of utmost importance during recovery. Cases of MOP caused by Canine Leucocyte Adhesion Deficiency (CLAD) can be prevented by screening Irish setters for the gene causing that condition (Kijas et al. 1999)

2. Panosteitis

Affected dogs should not be bred from. Usage of complete and balanced diets in restricted amount is the only preventive measures that can be instituted in this condition and of utmost importance during recovery. As excessive calcium intake during an early phase of growth (3-6 weeks of age) have been related to panosteitis (Hazewinkel et al. 2000), it is essential to keep the calcium level at an optimal level already from that age.

3. Patella luxation

Affected dogs should not be bred from. Screening of breeding stock is advisable in many breeds.

4. OCD

Affected dogs should not be bred from. Usage of complete and balanced diets in restricted amount is essential in large sized breeds.

5. Retained cartilage

Affected dogs should not be bred from. Usage of complete and balanced diets in restricted amount is essential in large sized breeds.

6. Elbow Dysplasia / Elbow arthrosis

Dogs affected by any of the primary causes of elbow dysplasia and resulting elbow arthrosis should not be used for breeding. In several countries and many breeds, screening programs assist in selecting unaffected breeding stock. Based on that and information on verified clinical cases also family information can be made available and should be taken into account when selecting suitable breeding stock in breeds as i.e., Bernese Mountain Dog, German Shepherd, Golden Retriever, Labrador Retriever, Rottweiler and New Foundlands.

Usage of complete and balanced diets is essential in growing dogs of breeds prone to develop Elbow Dysplasia as well as a restricted food intake.

7. Hip Dysplasia

In most large sized breeds, screening for Hip Dysplasia, is an effective tool to identify unaffected breeding stock. In most breeds, affected individuals should not be used for breeding. By extensive screening in many breeds and several countries, results from relatives, including progeny already produced, can be included and thereby improve the selection of breeding stock.

Complete and balanced diets should be fed in restricted amounts to growing dogs of any breeds prone to develop Hip Dysplasia.

8. Legg-Calve-Perthes

Affected dogs should not be bred from. Concern about further breeding from breeding stock that has produced affected progeny.

9. Cruciate ligament injuries

Affected dogs should not be bred from unless proven that the cause is truly traumatic

10. Fragmented sesamoid bone

In Greyhounds, Labradors, Rottweilers and other breeds predisposed to develop fragmentation of the sesamoid bones there should be a concern about breeding affected animals.

11. Degenerative Osteoarthritis

Individual dogs having developed osteoarthritis from developmental skeletal disease should not be used for breeding. To prevent further joint damage, weight reduction is advised and the further development might benefit from chondro-protective and anti-inflammatory nutraceuticals.

12. Arthropod arthritis

To prevent from exposure to Tick- borne infections usage of Tick- repellent products is recommended for use in exposed Dogs.

13. Osteosarcoma

In giant dogs, maximal height by excessive food intake should not be promoted.

D. Future developments

Most of the risk factors discussed here were not known 50 years ago and it is plausible that over the years to come, several others will be added. To refine tools to select breeding stock with reference to skeletal health, gene tests might be available to identify major genes affecting structure and function of articular cartilage, bone tissue and ligaments. Applying such information to breeding programs, together with results from conventional screening programs and registries, call for open registries and computer assisted calculations of breeding values and risk predictions.

Chondro-protective and anti-inflammatory properties of nutraceuticals might be better understood and proven to prevent from degenerative processes in the skeleton during growth and aging.

References

1.  Arokoski J, Kiviranta I, Jurvelin J, Tammi M, Helminen HJ. Long-distance running causes site-dependent decrease of cartilage glycosaminoglycan content in the knee joints of beagle dogs. Arthritis Rheum. 1993 Oct; 36(10): 1451-9

2.  Bonnett B, Egenvall A, Olson P and. Hedhammar A. Mortality in insured Swedish dogs: rates and causes of death in various breeds. Vet.Rec. 1997; 141 (2): 40-44

3.  Campbell BG, Wootton JA, Krook L, DeMarco J, Minor RR. Clinical signs and diagnosis of osteogenesis imperfecta in three dogs. J Am Vet Med Assoc. 1997 Jul 15;211(2):183-7.

4.  Egenvall A, Bonnett BN, Olson P, Hedhammar Å Gender, age and breed pattern of diagnoses for veterinary care events in insured dogs during 1996. Vet Rec 2000;146 (19):551-7

5.  Duval JM, Budsberg SC, Flo GL, Sammarco JL. Breed, sex, and body weight as risk factors for rupture of the cranial cruciate ligament in young dogs. J Am Vet Med Assoc. 1999 Sep 15; 215(6): 811-4 Goedegebuure SA, Hazewinkel HA. Morphological findings in young dogs chronically fed a diet containing excess calcium. Vet. Pathol. 1986 Sep; 23(5): 594-605

6.  Hazewinkel HA, Nap RC, Schoenmakers I, Voorhout G Dietary influence on development of enostosis in young dogs, Vet Surgery 2000; 29:279

7.  Hedhammar A, Wu FM, Krook L, Schryver HF, De Lahunta A, Whalen JP, Kallfelz FA, Nunez EA, Hintz HF, Sheffy BE, Ryan GD Overnutrition and skeletal disease. An experimental study in growing Great Dane dogs, Cornell Vet. 1974; 64: Suppl. 1-

8.  Hedhammar A, Olsson SE, Andersson SA, Persson L, Pettersson L, Olausson A, Sundgren PE Canine hip dysplasia: study of heritability in 401 litters of German Shepherd dogs, J.Am.Vet.Med.Assoc.1979; 174: 1012-1016

9.  Hedhammar Å, Swenson L, Egenvall A Elbow arthrosis and hip dysplasia in Swedish dogs as reflected by screening programmes and insurance data,

10. Europ.J.Comp.Anim.Pract.1999;IX: 119-121

11. Kasström H. Nutrition, weight gain and development of hip dysplasia. An experimental investigation in growing dogs with special reference to the effect of feeding intensity. Acta Radiol 1975: Suppl.344: 135-79

12. Kealy RD, Lawler DF, Ballam JM, Lust G, Biery DN, Smith GK, Mantz SL. Evaluation of the effect of limited food consumption on radiographic evidence of osteoarthritis in dogs. J Am Vet Med Assoc. 2000 Dec 1;217 (11):1678-80

13. Kijas JM, Bauer TR, Jr., Gafvert S, Marklund S, Trowald-Wigh G, Johannisson A, Hedhammar A, Binns M, Juneja RK, Hickstein DD, Andersson L. A missense mutation in the beta-2 integrin gene (ITGB2) causes canine leukocyte adhesion deficiency. Genomics 1999;61:101-107

14. LaFond E, Breur GJ, Austin CC Breed susceptibility for developmental orthopedic diseases in dogs.J Am Anim Hosp Assoc. 2002 Sep-Oct;38(5):467-77.

15. Mellanby E Nutrition in relation to bone growth and the nervous system. Proc.Roy.Soc. 1944; 132:28-46 Nap RC, Hazewinkel HA, Voorhout G, Van den Brom WE, Goedegebuure SA, VanT Klooster AT. Growth and skeletal development in Great Dane pups fed different levels of protein intake. J Nutr 1991; 121(11 Suppl): S107-13

16. Ru G, Terracini B, Glickman LT. Host related risk factors for canine osteosarcoma. Vet J. 1998 Jul;156(1):31-9

17. Sallander M, Hedhammar A, Rundgren M, Lindberg JE. Repeatability and validity of a combined mail and telephone questionnaire on demographics, diet, exercise and health status in an insured-dog population. Prev Vet Med 2001; 19; 50 (1-2): 35-51

18. Slater MR, Scarlett JM, Donoghue S, Kaderly RE, Bonnett BN, Cockshutt J, Erb HN. Diet and exercise as potential risk factors for osteochondritis dissecans in dogs. Am J Vet Res 1992; 53 (11):2119-24

19. Swenson L, Audell L, Hedhammar A Prevalence and inheritance of and selection for hip dysplasia in seven breeds of dogs in Sweden and benefit: cost analysis of a screening and control program, J.Am.Vet.Med.Assoc. 1997; 210: 207-214

20. Swenson L, Audell L, Hedhammar A (1997), Prevalence and inheritance of and selection for elbow arthrosis in Bernese Mountain Dogs and Rottweilers in Sweden and benefit: cost analysis of a screening and control program, J Am Vet Med Assoc 210: 215-221

21. Trowald-Wigh G, Ekman S, Hansson K, Hedhammar A, Hard af Segerstad C. Clinical, radiological and pathological features of 12 Irish setters with canine leucocyte adhesion deficiency. J Small Anim Pract. 2000 May;41(5):211-7.

22. Wood JL, Lakhani KH. Hip dysplasia in Labrador retrievers: the effects of age at scoring. Vet Rec. 2003 Jan 11; 152(2): 37-40

Speaker Information
(click the speaker's name to view other papers and abstracts submitted by this speaker)

Åke Hedhammar, DECVIM
Professor Internal Medicine
Companion Animals Department of Small Animal Clinical Sciences
Swedish University of Agricultural Sciences
Uppsala, Sweden


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