Surveillance results and bone effects in the Gulf War depleted uranium-exposed cohort

ABSTRACT

A small group of Gulf War I veterans wounded in depleted uranium (DU) friendly-fire incidents have been monitored in a clinical surveillance program since 1993. During the spring of 2017, 42 members of the cohort were evaluated with a protocol which includes exposure monitoring for total and isotopic uranium concentrations in urine and a comprehensive assessment of health outcomes including measures of bone metabolism, and for participants >50 years, bone mineral density (BMD) determination. Elevated urine U concentrations were observed in cohort members with retained DU shrapnel fragments. Only the mean serum estradiol concentration, a marker of bone metabolism, was found to be significantly different for lower-vs- higher urine U (uU) cohort sub-groups. For the first time, a significant deficit in BMD was observed in the over age 50, high uU sub-group. After more than 25 years since first exposure to DU, an aging cohort of military veterans continues to exhibit few U-related adverse health effects in known target organs of U toxicity. The new finding of reduced BMD in older cohort members, while biologically plausible, was not suggested by other measures of bone metabolism in the full (all ages) cohort, as these were predominantly within normal limits over time. Only estradiol was recently found to display a difference as a function of uU grouping. As BMD is further impacted by aging and the U-burden from fragment absorption accrues in this cohort, a U effect may be clarified in future surveillance visits.

KEYWORDS:

• Uranium toxicity
• health surveillance
• DU bio-monitoring
• bone mineral density

Acknowledgments

This program is funded through the U.S. Department of Veterans Affairs, a governmental agency providing medical care for veterans of military service. We thank the staff and administration of the General Clinical Research Center at the University of Maryland Medical Systems Hospital, the Depleted Uranium Follow-Up Program administrative staff, and the Baltimore Veterans Administration Clinical Laboratories for their invaluable assistance.

The surveillance protocol used in this study was approved by the University of Maryland School of Medicine’s and the Baltimore VAMC’s IRB programs.

The work described in this article has been carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki) for experiments involving humans.

The identification of specific products or scientific instrumentation does not constitute endorsement or implied endorsement on the part of the authors, the Department of Defense or any component agency. The views and/or assertions expressed in this article are those of the authors and do not reflect the official policy of the Department of Veterans Affairs, Department of Army/Navy/Air Force, Department of Defense, or U.S. Government.

Additional information

Funding

This work was supported by the U.S. Department of Veterans Affairs Veterans Administration.