Abstract
Summary
The submarine environment is unique in that there is limited space and no sunlight, which may negatively affect skeletal health and lead to accelerated bone loss, osteoporosis, and fractures.
Introduction
The primary purpose of this study was to determine whether there was an association with submarine service, specifically time spent at sea, and bone mineral content (BMC) and bone mineral density (BMD) of the lumbar spine and dual proximal femur (total hip and femoral neck) measured by DXA.
Methods
This is a cross-sectional study of 462 submariners 20–91 years old. Variables included in the analysis were age, height, race, alcohol intake, tobacco use, fracture history, conditions, and medications known to cause bone loss and osteoporosis and submarine service.
Results
Of the submarine service predictors, only serving onboard a diesel submarine was determined to be independently associated with a reduction in BMD of the total hip and femur neck, while no submarine service predictor increased the odds of having low BMD. In submariners 50+ years old, the age-adjusted prevalence of osteopenia was 15.7 % (lumbar spine) and 40.4 % (femur neck), while the prevalence of osteoporosis was 4.8 % (lumbar spine) and 4.2 % (femur neck), rates that did not differ from NHANES 2005–2008. In submariners <50 years old, 3.1 % was below the expected range for age. The proportion of submariners 50+ years old that met the FRAX criteria for pharmacological treatment was 12 %.
Conclusions
Intermittent periods of submergence that can range from a few days to 3+ months do not appear to compromise skeletal health differently than the general population.
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Acknowledgments
We would like to extend our gratitude to our subjects for their participation in this study. In addition, we would like to thank the Commander, Submarine Force, and Submarine Force Atlantic Medical Officer (Commander Jeffery McClellen) for their permission to conduct this investigation. We would also like to thank Dr. Scott Smith, Dr. Jean Sibonga, Dr. Robert Ploutz-Snyder (NASA), LT Joshua Swift (Armed Forces Radiobiological Research Institute), and CDR Fred Yeo for their contribution towards improving the quality of this research/manuscript. Additional thanks are warranted to HMCM Darrin Way, Ms. Abaigeal Caras, Mr. Andrew Way and Mr. David Kerr (NSMRL), and the Radiology Department (Naval Branch Health Clinic, Groton) for their technical assistance with this research. Finally, we acknowledge the work in undersea medicine conducted over the years by the former Dr. Wayne Horn (deceased) that planted the seed for this research.
Funding/support
This work was supported by the Office of Naval Research, Warfighter Performance Department (Code 34), work unit number N0001411WX20143.
Disclaimer
The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense nor the US Government.
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Gasier, H.G., Hughes, L.M., Young, C.R. et al. The assessment of bone mineral content and density of the lumbar spine and proximal femur in US submariners. Osteoporos Int 25, 2225–2234 (2014). https://doi.org/10.1007/s00198-014-2753-y
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DOI: https://doi.org/10.1007/s00198-014-2753-y