ORIGINAL ARTICLE

Reduced bone formation in UK Gulf War veterans: a bone histomorphometric study

J E Compston¹, S Vedi¹, A B Stephen², S Bord¹, A R Lyons², S J Hodges³ and B E Scammell²

¹ Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge CB2 2QQ, UK
² Department of Orthopaedic and Accident Surgery, University Hospital, Queen’s Medical Centre, Nottingham NG7 2UK, UK
³ Department of Biological Sciences, University of Essex, Colchester CO4 35Q, Essex, UK

Correspondence to:
Correspondence to:
Dr J E Compston, Department of Medicine, Level 5, Box 157, Addenbrooke’s Hospital, Cambridge CB2 2QQ, UK;
jec1001{at}cam.ac.uk

Aims: Gulf War veterans report a high prevalence of musculoskeletal symptoms. The aim of this study was to establish whether there were abnormalities in bone turnover and remodelling in a group of symptomatic subjects who had served in the Gulf War.

Methods: Iliac crest bone biopsies were obtained from 17 Gulf War veterans who were seeking litigation and compared with those of 13 age and sex matched healthy controls. Bone histomorphometry was performed using image analysis.

Results: Cancellous bone area was significantly lower in Gulf War veterans than in control subjects (p = 0.027) and this was associated with a significantly reduced mineral apposition rate (p = 0.002), mean wall width (p < 0.0001), and bone formation rate at the tissue level (p < 0.0001).

Conclusions: These results demonstrate that in this group of Gulf War veterans there was a significant reduction in bone formation at both the cellular and tissue level and this was associated with a reduction in cancellous bone area. The cause of these abnormalities is unknown but might be related to potentially harmful exposures during service in the Gulf War or to changes in life style as a result of chronic ill health. The clinical relevance of the observed reduction in bone formation remains to be established.

Keywords: Gulf War syndrome; Gulf War veterans; bone histomorphometry; organophosphates; reduced bone formation

Abbreviations: Acf, activation frequency; B.Ar, bone area; BFR/B.Pm, tissue based bone formation rate; B.Pm, bone perimeter; dL.Pm, double labelled perimeter; LP, labelling period; L.Wi, interlabel width; MAR, mineral apposition rate; Md.Pm, mineralising perimeter; O.Pm, osteoid perimeter; sL.Pm, single labelled perimeter; T.Ar, tissue area; W.Wi, wall width

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This article has been cited by other articles:

• Blatchley, N F W, Lee, H A, Bolton, J P G (2003). Reduced bone formation in UK Gulf War veterans: a bone histomorphometric study. J. Clin. Pathol. 56: 559-559 [Full Text]  
• Freemont, A J (2002). Bone and the Gulf War. J. Clin. Pathol. 55: 884-884 [Full Text]