Interesting. It sounds like solid reasoning, but I’m not a scientist. I appreciate you sharing your knowledge with us.
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You might find this interesting, and no doubt are far more capable than I in terms of interpreting and understanding it 
This was the paper my onc sent me a few year back trying to explain risks involved with Zometa and BIONJ.
Anyway… exactly as you said, there is the whole risk related aspect of trauma to the jawbone when people have surgery or other dental procedures that is linked to BIONJ. But, there there is also this aspect of the jawbone itself that I vaguely recollected …
Dixon et al. studied bone remodeling at various sites and found that alveolar crest remodels at ten times the rate of tibia and five times the rate of mandible at inferior border. Hence, alveolar bone of the jaws has greater uptake of bisphosphonates and drug accumulates in higher concentration. This study also demonstrated that alveolar bone depends more on osteoclastic remodeling and renewal than any other bone in adult skeleton [16].
Anyway, I remember reading that at some point and the horse related part of my brain thinking about Osphos and wondering if there were weird increased rates of complications in some specific part of the equine skeleton that seemed slightly random and coincidental, but might actually be linked to the way the medication was taken up.
I’m not articulating it well. 
But the thought is essentially that bisphosantes don’t necessarily accumulate in even concentrations in the skeleton, for various reasons.
Fortunately I didn’t need to take a bisphosphonate long term. Or at higher doses. But it all does make me wonder what the eventual risks might be for horses that receive bisphosponates on a longer term basis, such as part of an annual maintenance schedule. From what I understand, they can remain in the bone for a long time (decades in some cases with human medications)… and they can accumulate. Maybe specific fractures will become more common, like you mentioned seeing in women who use these meds long term.
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@Carried_Away I need to add that I’ve gone away from wraps and boots both in training and competition.
I only do front open fronts and hind ankle boots when jumping, stadium and XC (schooling and competition). I make sure they are the first things that come off when we are done. Plenty of work going back 30 years shows that excessive tissue temperature (105F and above) cause accumulating micro damage to tendons and ligaments during work. I try to keep the legs as open to cooling while working now.
This goes back to not just conditioning and training the horse as a whole but also conditioning/training them at the cellular level. It takes a lot longer but I believe it keeps them sounder for their lives.
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From what I understand injections are on the way out, and fixing the way horses go and carry themselves, watching body condition etc is going to be the new way forward. Injections will still be there of course but they won’t be the first bandaid slapped on, instead vets and owners will work in looking at what could be causing the issues. Injections needed are often a symptom of something happening elsewhere. I have also heard on some vet based podcasts that specifically injecting the SI created more issues over time and the injections work less and less.
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Dear god I hope so.
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Maybe it’s relevant, maybe not.
Cudo is a 17 yr old higher level show jumper with me. Much of what @RAyers said applies to us.
He gets joint injections every 2 years. We have done hocks every time and stifles the last 2 times.
That and regular Pemf (once every 6 weeks or so) and chiro (once every 3-4 months)
He gets Adequan as well, on average one series a year. And that’s it. No ice after show classes. Maybe a bit of cold hosing but not much.
Wraps when merited but mostly those have been at shows when the stalls are smaller than home and it’s a bit like bubble wrap that helps me sleep at night.
He gets a lot of turnout (12 hrs a day) which is the max our barn can handle with only 3 acres of turnout and 4 horses.
He gets EVERY WINTER OFF. Period. hind shoes pulled and feral pony days.
It’s been great for us and he is still raring to go. We only go to shows every 3-5 weeks as it’s the best schedule for him and my budgets 
But for sure nothing oral. No ice and more hacks and flatwork than repetitive schools and shows. Horse knows how to jump so we jump maybe once every 2 weeks. Once a week happens in lessons only with an eye on an upcoming show.
Em
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I used to do shoes pulled and 3 months off every winter. But noticed as he started to age, it was actually taking him longer to come back, and seemed more NQR with the lack of movement. He’s now kept in work, not as intense obviously over the winter, but shoes are kept on all year round now.
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Every horse is an individual. Never had problems legging back up. We start with roadwork primarily first. Then bring ring work back.
Em
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I’ve had the same issues with farriers unfortunately. I now take X-rays of feet pretty regularly even with one I trust to make sure we’re on the right track!
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Same. My guy turned 15 this year and I found it was more beneficial to keep hacking him through the winter. He’s out 24/7 but the previous winter I still felt he lost a little topline with 2-3 months completely off. I do pull hind shoes for 3-5 months depending on the timing of our first and last events. He has always passed his pre-season soundness check with flying colors. I typically do a course of Adequan in March and August.
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My biggest concern with eventing in particular is the varied/bad ground conditions. Not everyone has access to well maintained gallops or aerovated grass for conditioning, not to mention that many events don’t have the resources to offer improved XC footing, especially in the Midwest. Heck even in Ocala this winter the ground was hard! No amount of posture/good training/bodywork can remedy that. I agree with the long slow road work and have always done it, but I’d argue that if you want to event you have to do some sort of speed work as well. I did do some Aquatread sessions last winter which were helpful, but ultimately did not replace proper gallop sets. Edited to add: I realize horses have to train on varied ground to become acclimated to it, I’m not suggesting only riding on a surface but just wondering how to make it all work.
I know a few ex-event horses that have now gone to straight SJ because they couldn’t stay sound from all the pounding, even with really good daily care + vet maintenance. I’m personally struggling with this for my own horse, as I’m not sure I see the point of making his existing issues worse with the continued wear and tear of eventing at the upper levels. The lighter TB types I’ve had in the past have definitely fared better overall, although many of them still developed soundness issues later in their careers. I know horses are individuals, just trying to make sense of it all (which is futile with horses, I know!).
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That is why we condition on paved roads, dirt roads, plowed fields,… I did a 20 minute trot on paved hills yesterday. And it has been well proven this work does create better quality and denser tissues. We studied using shock loading for reducing bone loss in orbit. It works great on earth. Look at Larry Bramlage’s work on race horses and soundness. Training on varied footing and with different speeds do the most to extend the longevity of a horse’s competitive career.
The old school methods developed horses with thick bone, tendon, and ligaments. That is how you train them for varied terrain. I am going to opine this is why east coast horses have more issues than those out west.
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They hold up on this 
because I do this 
(upload://dK5DXz3q3xJJ3dlDGCQF3Gcnc4m.jpeg)
That is what I mean in my first post. You have to beat them up in training g so their body can handle competition.
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Reed,
I used to show people a study done by Winky Mackay-Smith about conditioning endurance horses, and how gradually increasing work on hard surfaces increased bone. Do you have a link to that or a similar study?
When conditioning foxhunters, we do short trot and canter sets on pavement, not to mention occasionally needing to do longer ones while hunting. Some people are horrified by this and think it’s animal cruelty; I point to a barn full of sound horses hunting well into their 20s.
Would love to have some recent research to back this up.
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“It’s the 'ammer, 'ammer, 'ammer on the 'ard high road.”
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I held off on replying because I have only ever brought a horse up to Preliminary level eventing so I didn’t really feel like an authority on the subject, but I’ve taken care of my fair share of UL event horses for BNT riders.
The biggest factor in their soundness was their turnout. All the PEMF, magnawave, icing, poulticing, won’t come close to the benefits the horse gets from 24/7 access to movement in a pasture. Note: 24/7 turnout on a flat dirt lot is not the same.
IMO if you want an unsound horse, stall it.
If the horse is out 24/7, it’s not a requirement to keep them conditioned on paved roads. They’ll develop that limb conditioning just from being out. I was one of the main exercise riders for a BNT during long format days and spent a lot of time conditioning on pavement. It is hard on their bodies. Shod horses have a harder time, but being barefoot (unlikely at the UL anyway) is not so good either, the road shears off their hoof. Short and sweet on pavement is best, and you can save the gallop/trot sets for dirt roads if you can.
If I remember right, I was told by a race vet that 2 minutes at speed (trot+) on pavement once a week was all you[g] needed for positive changes in bone remodeling. Anything more poses other risks like backsoreness and concussive injuries.
On the topic of ridden work, spend more time out on terrain versus in an arena or GGT footing-type surface. What stuck with me all these years later in one of the BNT barns that I conditioned horses for was how much saddle time we got outside of the ring in a week. Any given day we might log 30-45m in the arena, but 2+ hours on the roads or trails. I was never in such good riding shape as I was that summer.
Keeping a log of what you do also helps; it’s immensely valuable to look back and see how much time you spent in a ring, out of the ring, etc over long periods of time.
The northeast coast has a lot of mud and tragically short seasons that makes year round riding conditioning difficult. The southeast coast has a lot of hard ground and not so many hills. Both have limited riding space and fewer and fewer areas where you can actually condition a horse. Both have their pluses and their draws. I haven’t heard much about east coast horses having more issues than west coast.
Maintenance wise, the long-format BNT I worked for really didn’t do much more than poultice after road & track days or events, and chuck them out. They were not stalled ever and she hated icing. One had yearly hock injections but he was also an older campaigner. All the horses in this program were the soundest horses I ever took care of, which said a lot because IMO their bodies were used harder than today’s UL horses.
Today’s horses also have the benefit of modern therapies, which can be a good and bad thing. It’s easier to address things therapeutically than change management, but I also think these modern advances in treating overall body soreness can come at the cost of pushing the horse past his physical limit.
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I know a number of people who have shown at a 5* show jump facility with GGT footing. They all say their horses come up sore by the end of the week, whereas on the previous footing, they didn’t.
Their theory is that it provides too much grip, so is stopping the horse’s hooves with each step.
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Soreness in a horse is a tell tale, a sign of potential problems before they become big issues. That is why I’m totally against dosing horses with prophylactic painkillers or anti-inflammatory meds etc “just in case”, or “to keep them comfortable”. I’m very doubtful about the idea of “serviceably sound”.
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I agree with this at the ULs, but think at LLs servicably sound has its place since the ask (and risks associated) is so much smaller. Especially when it’s between that or a “french vacation”. Unless that is what you meant, UL only?
Everything else you said I agree with fully.
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My horse goes lame in that footing, so I avoid it as much as possible.
