Surveillance of Depleted Uranium-exposed Gulf War Veterans: More Evidence for Bone Effects

Abstract

Gulf War I veterans who were victims of depleted uranium (DU) “friendly-fire” incidents have undergone longitudinal health surveillance since 1994. During the spring of 2019, 36 members of the cohort were evaluated with a monitoring protocol including exposure assessment for total and isotopic uranium concentrations in urine and a comprehensive review of health outcomes, including measures of bone metabolism and bone mineral density (BMD) determination. Elevated urine U concentrations were observed in cohort members with retained depleted uranium (DU) shrapnel fragments. In addition, a measure of bone resorption, N-telopeptide, showed a statistically significant increase in those in the high DU subgroup, a finding consistent with a statistically significant decrease in bone mass also observed in this high DU subgroup compared to the low DU subgroup. After more than 25 y since first exposure to DU, an aging cohort of military veterans continues to show few U-related health effects in known target organs of U toxicity. The new finding of impaired BMD in the high DU subgroup has now been detected in two consecutive surveillance visits. While this is a biologically plausible uranium effect, it is not reflected in other measures of bone metabolism in the full cohort, which have largely been within normal limits. However, ongoing accrual of the U burden from fragment absorption over time and the effect of aging further impairing BMD suggest the need for future surveillance assessments of this cohort.

The Department of Veterans’ Affairs Depleted Uranium Cohort in the Time of COVID-19

“…The low-uU group is defined as those having uU < 0.1 μg U/g creatinine. 15,17,26 High exposure was defined as current uU concentrations ≥0.1 μg U/g creatinine, a value between 0.043 μg U/g creatinine (the 95% percentile reported for creatinine-adjusted uU concentrations in nonexposed populations in the United States) 27 and 0.35 μg U/L, which is reported as a uU upper limit that occurs naturally in areas with elevated U in water and food. 28…”

“…An initial and now persistent finding over this 30-year follow-up is the excretion of elevated concentrations of urine uranium (uU) in those cohort members with retained metal fragments. 14–17 This observation indicates the systemic absorption of metal ions from embedded fragments, illustrating not only concern for local tissue effects, but toxic metal exposure of organ systems far from the site of the retained fragments.…”

“…Significant and consistent decreases in bone mineral density among veterans with higher DU burden have been found in recent assessments. 16,17 Other uranium-related clinical findings and abnormal laboratory measures have not been consistently observed. However, given that chronic, systemic absorption continues with the mobilization of metal ions from fragment depots in soft tissue, ongoing surveillance has continued.…”

Wounding characteristics and treatment principles of ground anti-armored vehicle ammunition against armored crew

“…Otherwise, bone density is decreased, but the toxicity for kidney, liver and nerve system is increased. 20 , 28 , 29 Animal experiments also revealed that interstitial inflammation, fibrosis, edema, hemorrhage of the lung and emphysema can be induced by DU aerosol. 27 …”