title: Trends in vertebral augmentation for spinal fractures in myeloma patients: a 2002-2012 population-based study using a large national cancer registry.
abstract: OBJECTIVE
  To evaluate temporal trends and factors associated with vertebral augmentation use in myeloma patients with spinal fractures from 2002 to 2012.
  
  
  METHODS
  This retrospective cohort study used the Surveillance, Epidemiology and End Results (SEER)-Medicare claims database for 2002 through 2012. We included patients age ≥66 years with myeloma and spinal fractures. First, we evaluated receipt of vertebral augmentation. Second, multivariate logistic regression was used to assess the impact of sociodemographic factors, treatment facility type, and underlying comorbidities on the odds of undergoing vertebral augmentation.
  
  
  RESULTS
  Of 4725 myeloma patients with spinal fractures, 653 underwent vertebral augmentation. Procedures increased initially from <1.7% in 2002 to 21.0% (109/520) in 2007, 18.6% (81/435) in 2008, 21.4% (109/509) in 2009, and 17.5% (76/435) in 2011. Patients with a spinal fracture before myeloma diagnosis were twice as likely to undergo vertebral augmentation as patients with fracture after myeloma diagnosis (OR 2.06, 95% CI 1.55 to 2.75). Black patients were half as likely to undergo vertebral augmentation as white patients (OR 0.48, 95% CI 0.34 to 0.68). Patients with 3-5 comorbidities (OR 0.78, 95% CI 0.64 to 0.96) and ≥6 comorbidities (OR 0.69, 95% CI 0.54 to 0.87) were less likely than patients with 0-2 comorbidities to undergo vertebral augmentation.
  
  
  CONCLUSIONS
  Vertebral augmentation for myeloma patients with spinal fractures peaked between 2007 and 2009 and then declined. Providers may have adopted vertebral augmentation in myeloma patients since its introduction, and potentially modified practice patterns following the publication of trials of vertebral augmentation in patients with osteoporotic spinal fractures.
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Falgun H
authors.identifier: http://orcid.org/0000-0002-8476-9129
authors.initials: FH
authors.lastname: Chokshi
authors.affiliation: Department of Health Policy and Management, Rollins School of Public Health (Emory), Atlanta, Georgia, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Howard
authors.affiliation: Departments of Radiology, Neurological Surgery and Health Services, University of Washington School of Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: Jeffrey G
authors.initials: JG
authors.lastname: Jarvik
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Duszak
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare / Q000639:trends*; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D012042:Registries; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D014481:United States / Q000453:epidemiology
keywords: Malignant; Spine; Tumor