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Hypertrophic Osteodystrophy (HOD) is a bone disease that usually affects young, rapidly growing, large or giant breed dogs, including Irish Setters, German Shepherds, Labrador Retrievers, Doberman Pinchers, Basset Hounds, Great Danes, and Borzois. The disease produces severe lameness and pain and usually affects multiple limbs. Some puppies suffer permanent disability. Many recover later, but others die from HOD. The disease is so painful that many owners elect to euthanize puppies rather than watch them suffer, despite the reasonably good chance for recovery long term. HOD has several names, including skeletal scurvy, Moller-Barlow's disease, osteodystrophy II, and metaphyseal osteopathy.
In addition to the information provided below, more about HOD is available from S. Gary Brown, DVM, DACVS and Roy R. Pool, DVM, PhD. In their 2007 paper they provide clinical signs, pathophysiological changes, causes and predispositions, and treatment recommendations.
The cause of HOD is currently unknown and it's possible that the disease may have several causes. One possible cause may be a bacterial infection. The occurrence of bony changes and high fever support this possibility. However, it is often difficult to obtain a bacterial culture. In addition, there is sometimes a poor response to antibiotic therapy, fueling the argument against bacteria as a possible cause.
Vitamin C deficiency has also been suspected as a possible cause because dogs with HOD show very similar symptoms and bony changes to people with scurvy. In addition, dogs with HOD often have lowered blood levels of vitamin C. However, dogs synthesize their own vitamin C and do not have a nutritional requirement for this vitamin. Supplementation with Vitamin C is contraindicated due to increased calcium levels in the blood, which may worsen the condition. In addition, studies have not proven that feeding affected dogs high doses of vitamin C alters or cures the disease. It is possible that low blood levels of vitamin C are a result of the disease, not the cause.
Another possible cause of the disease may be excess protein and calories in the diet of young puppies. However, studies have not been done to confirm this.
The signs of HOD include:
Diagnosis is based on the history, symptoms, physical exam showing pain and swelling at the growth plates. In addition, x-rays show a thin radiolucent (dark) line at the metaphysis (growth plate) in the end of the ulna, radius, or tibia. Bony inflammation and bone remodeling may also be seen at these sites. Occasionally, there may be involvement and changes in the skull and teeth.
The treatment for HOD is supportive. Anti-inflammatory medications and painkillers, such as buffered aspirin or carprofen (Rimadyl), are used to treat pain. In severe cases steroids may need to be given to control the pain. In addition, broad-spectrum antibiotics are often used. Strict rest on a comfortable, warm bed is recommended. A nutritious, highly palatable food will help to encourage some dogs to eat. Vitamin C is often supplemented though its benefit may be questionable. In severe cases, steroids may be used.
Many owners of large and giant breed puppies are feeding diets lower in fat and protein to encourage moderate steady growth instead of rapid growth.
Hypertrophic osteodystrophy is a self-limiting disease that can last for a few weeks per episode and can be managed with medications and other changes. However, the condition may recur until the dog is eight to ten months of age. Owners should be sure the dog avoids strenuous exercise (including running and long walks) on hard surfaces such as concrete and asphalt until the puppy has matured. Also, puppies should not be allowed to jump up or down from any sort of height, such as into or out of an SUV or pick-up truck, on or off the sofa or bed, or over walls and other obstacles. It is generally recommended that dogs that are severely affected by the disease and are unresponsive to treatment should be euthanized.
Two grants to study the genetic causes of HOD in Irish Setters and Weimaraners have been funded by CHF.
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