Tiludronate is a compound in the bisphosphonate class of drugs. The main pharmacologic action of bisphosphonates is to inhibit bone resorption; they cause osteoclast apoptosis and disrupt intercellular trafficking of pro-inflammatory mediators. Bisphosphonates are used to treat humans with diseases such as osteoporosis and Paget's disease. Recently tiludronate has been studied as a treatment for bone resorptive diseases in horses. Tildren, an injectable form of tiludronate made for the horse, has been licensed to treat navicular disease and distal tarsal osteoarthritis in Europe. Some clinical studies have been completed to assess the efficacy of tiludronate in the horse. Many of the studies are reviewed here, and their standards of research are evaluated individually. Tiludronate may be beneficial in managing lameness isolated to the navicular bone and distal tarsal osteoarthritis by decreasing bone resorption and inflammation.