Utilization Trends of Recombinant Human Bone Morphogenetic Protein in the United States

Panagiotis Kerezoudis, Mohammed Ali Alvi, Brett A. Freedman, Ahmad Nassr, Mohamad Bydon

Research output: Contribution to journalArticlepeer-review


Study DesignRetrospective.ObjectiveThe aim of this study was to explore the utilization trends of recombinant human bone morphogenetic protein (rh-BMP) in the United States using the largest inpatient administrative database.Summary of Background DataSince 2002, the rh-BMP has been widely used by the surgical spine community in fusion surgery. In light of the rising evidence regarding the safety and efficacy of this novel and expensive bone biological technology, a comprehensive examination of its utilization in the American population is warranted.MethodsWe queried the 2002-Q3 2015 National Inpatient Sample for patients that underwent spinal fusion with rh-BMP. We calculated population-level estimates of rh-BMP utilization trends per 100,000 spinal fusions. Trends were estimated for the overall use as well as broken down by primary versus revision fusion, fusion type, number of levels, age category, US region, and hospital type.ResultsA total of 5,563,282 fusions were performed, of which 19.9% (n=1,108,984) utilized rh-BMP. We detected an increase in rh-BMP use in spinal fusion surgery from 0.7% in 2002 to a peak of 29.5% in 2010, followed by a gradual decline till Q3 2015, where it represented 14.7% of all fusion surgeries. These trends paralleled all fusion types. It was most commonly used in fusions spanning two to three levels. The South remained the most common region, whereas West has recently surpassed the Midwest. Its use is becoming more pervasive among older patients, particularly in the 65- to 74 years' age group.ConclusionFurther studies are needed to provide insights into the correlation of these trends with the technology's safety and efficacy profile in contemporary series.Level of Evidence: 3.

Original languageEnglish (US)
Pages (from-to)874-881
Number of pages8
Issue number13
StatePublished - Jul 1 2021


  • bone morphogenetic protein
  • national inpatient sample
  • trends
  • utilization

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology


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