scott@vtx-cpd.com

Replying to Esther H. 12/07/2024 - 10:44

I do!

I use Chia seeds a lot in cats. I have popped a whole new post on regarding the topic. I am actually moving away from alendronate completely due to possible side effects:

“Hello everyone,

I wanted to share some insights from a recent study on the management of feline idiopathic ionised hypercalcaemia and ionised hypercalcaemia associated with chronic kidney disease. This study evaluates the efficacy of alendronate combined with standard treatment compared to standard treatment alone.

Study Overview:

Objectives:

To characterise the signalment, clinicopathologic data, complications, and the association between treatment and outcome in cats with idiopathic or chronic kidney disease-associated ionised hypercalcaemia.
To compare the outcome between cats managed with alendronate and standard treatment versus standard treatment alone.
Materials and Methods:

This retrospective cohort multicentre study reviewed medical records of cats diagnosed with idiopathic or chronic kidney disease-associated ionised hypercalcaemia.
Cats treated with alendronate and standard treatment were assigned to the alendronate group, while those treated with standard treatment alone were assigned to the control group.
Standard treatment included dietary modification, monitoring of ionised calcium concentrations, and managing complications secondary to hypercalcaemia.
The follow-up period was 6 months.

Results:

A total of 29 cats were enrolled in the study: 9 in the control group and 20 in the alendronate group.
Both groups showed a significant reduction in serum ionised calcium between the baseline and the follow-up visit. However, the reduction did not differ significantly between the two groups (mean change in ionised calcium concentration: -0.18 for the alendronate group and -0.17 for the control group).
Suspected bisphosphate-related osteonecrosis of the jaw was reported in one cat receiving alendronate.

Clinical Significance:

The study observed similar reductions in serum ionised calcium concentration in cats treated with diet alone and in those treated with diet and alendronate.

These results should be interpreted with caution as the study was underpowered for meaningful statistical comparison.
Cats receiving alendronate should be monitored for adverse reactions, including osteonecrosis of the jaw.
Additionally, it has been relatively well documented that using chia seeds can be a really effective non-pharmacological intervention for the management of hypercalcaemia, and this is certainly something that I would do very routinely. Generally speaking, I will now avoid alendronate in the management of idiopathic hypercalcaemia in cats. I am much more likely to turn to diet, chia seeds, or even prednisolone or steroids as management options rather than using alendronate.

Case Reports: Managing Feline Idiopathic Hypercalcemia With Chia Seeds (Salvia hispanica L.): A Case Series

Abstract:

Background: This case series describes the use of chia seeds (Salvia hispanica L.) as a non-pharmacological solution in managing feline idiopathic hypercalcaemia when dietary change alone fails.

Case Summary: Over a 2-year period, three female spayed, middle-aged, Domestic Shorthair cats were diagnosed with idiopathic hypercalcaemia. Initial management with various high-moisture pet foods did not result in normocalcemia. Supplementing the diet with chia seeds (2 g/cat/day) for 4 weeks resulted in normalization of ionized calcium concentration in all cats.

Conclusion: Chia seeds supplementation could be a useful tool in managing feline idiopathic hypercalcaemia.

Additionally, another paper highlights the potential complications associated with long-term bisphosphonate treatment:

Medication‐related osteonecrosis of the jaw after long‐term bisphosphonate treatment in a cat

Abstract:

Background: A 12‐year‐old, neutered female, domestic medium hair cat was evaluated for a nonhealing oral mucosal ulceration. The cat had a history of idiopathic hypercalcemia that had been treated with a bisphosphonate for 41 months. Oral examination identified exposed maxillary bone adjacent to a previous extraction site. Histopathology of the exposed bone and associated mucosa was most consistent with medication‐related osteonecrosis of the jaw. Treatment involved both medical and surgical interventions. Oral mucosal healing occurred after 6 months of treatment.

For more details, you can access the full studies here:

Assessment of alendronate and dietary treatment in the management of feline idiopathic ionised hypercalcaemia and ionised hypercalcaemia associated with chronic kidney disease: https://onlinelibrary.wiley.com/doi/10.1111/jsap.13755

Managing Feline Idiopathic Hypercalcemia With Chia Seeds (Salvia hispanica L.): A Case Series: https://www.ncbi.nlm.nih.gov/pmc/articles/pmc7387619/

Medication‐related osteonecrosis of the jaw after long‐term bisphosphonate treatment in a cat: https://www.ncbi.nlm.nih.gov/pmc/articles/pmc6430911/

I would love to hear your thoughts and experiences in managing feline hypercalcaemia. Have you found alendronate or chia seeds to be effective in your practice, and have you encountered any notable side effects?

Best regards,

Scott”

Hello again!

I have some information directly from Zoetis for you too. I will try and upload the documents mentioned too:

“Hi Scott,

I hope you are well and nice to meet you virtually! In regards to Rosanna’s questions, a negative effect on the function of the nervous system would not be an expected adverse effect of either Librela or Solensia. As Rosanna mentions, it is not unusual for some animals with OA to also have pre-existing neurological involvement, however, as the monoclonal antibodies are large molecules, they do not distribute outside of the blood very well and cannot cross into the CNS to any significant effect (in the absence of local severe inflammation such as meningitis). It is also worth noting that Librela and Solensia are also not designed to remove all nerve growth factor (NGF) in the body, only to reduce the elevated levels found in osteoarthritic joints. To give further context to this query, in studies on the human side for anti-NGF mAbs, exhaustive evaluation was conducted for altered sympathetic function and no changes were found.

In terms of what to advise clients in regards to potential adverse effects, the best source of information to share with them is section 4.6 within the respective SPC’s as these list the possible adverse reactions and also guide as to the frequency in which they would be expected. As these are written and amended on a regular basis from on-going pharmacovigilance (PV) and assessment from an independent regulator (the VMD), these form the most reliable guidance when discussing products with owners. Despite both products being licenced since 2021 with millions of doses being given (in excess of 14 million doses for Librela for example), few changes have been made to this section (both SPC’s attached) based on PV reports so hopefully this will give owners confidence and help guide the conversations.

I hope this is helpful but if you have any further queries, please let me know!

Best wishes

Jayne

Jayne Clark BVSc, BSc(Hons), GPCertSAM, MRCVS

Zoetis Veterinary Consultant, East Region”