Bone morphogenetic protein use and cancer risk among patients undergoing lumbar arthrodesis a case-cohort study using the SEER-medicare database

Daniel C. Beachler, Elizabeth L. Yanik, Brook I. Martin, Ruth M. Pfeiffer, Sohail K. Mirza, Richard (Rick) Deyo, Eric A. Engels

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background: Recombinant bone morphogenetic proteins (BMPs) are growth factors utilized in lumbar arthrodeses. Limited data from randomized trials suggest that BMP may increase cancer risk. We sought to evaluate cancer risk and mortality following the use of BMP in lumbar arthrodesis. Methods: Within the linked Surveillance, Epidemiology, and End Results (SEER) Program-Medicare cohort, we conducted a case-cohort study of 7,278 individuals who were ≥65 years of age and had undergone a lumbar arthrodesis from 2004 to 2011. Of these patients, 3,627 were individuals in a 5% random subcohort of Medicare enrollees in SEER areas including 191 who developed cancer, and there were 3,651 individuals outside the subcohort who developed cancer. Weighted Cox proportional-hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for cancer on the basis of exposure to BMP. Results: In the SEER-Medicare subcohort, 30.7% of individuals who underwent a lumbar arthrodesis received BMP. BMP was not associated with overall cancer risk in univariate analyses (HR, 0.92 [95% CI, 0.82 to 1.02]) or after adjustment for demographic characteristics, comorbidities, hospital size, history of cancer, and calendar year (adjusted HR, 0.94 [95% CI, 0.84 to 1.05]). Individual cancer types were also not significantly elevated (p > 0.05 for all) in BMP users compared with nonusers. In addition, BMP use was not associated with a new cancer in people who had cancer prior to undergoing lumbar arthrodesis (adjusted HR, 1.04 [95% CI, 0.71 to 1.52]) or withmortality after a cancer diagnosis (adjusted HR, 1.05 [95% CI, 0.93 to 1.19]). Conclusions: In a large population of elderly U.S. adults undergoing lumbar arthrodesis, BMP use was not associated with cancer risk or mortality.

Original languageEnglish (US)
Pages (from-to)1064-1072
Number of pages9
JournalJournal of Bone and Joint Surgery - American Volume
Volume98
Issue number13
DOIs
StatePublished - Jul 6 2016

Fingerprint

Bone Morphogenetic Proteins
Arthrodesis
Medicare
Epidemiology
Cohort Studies
Databases
Neoplasms
Confidence Intervals
Health Facility Size
SEER Program
Mortality
Recombinant Proteins
Comorbidity
Intercellular Signaling Peptides and Proteins

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)
  • Orthopedics and Sports Medicine

Cite this

Bone morphogenetic protein use and cancer risk among patients undergoing lumbar arthrodesis a case-cohort study using the SEER-medicare database. / Beachler, Daniel C.; Yanik, Elizabeth L.; Martin, Brook I.; Pfeiffer, Ruth M.; Mirza, Sohail K.; Deyo, Richard (Rick); Engels, Eric A.

In: Journal of Bone and Joint Surgery - American Volume, Vol. 98, No. 13, 06.07.2016, p. 1064-1072.

Research output: Contribution to journalArticle

Beachler, Daniel C. ; Yanik, Elizabeth L. ; Martin, Brook I. ; Pfeiffer, Ruth M. ; Mirza, Sohail K. ; Deyo, Richard (Rick) ; Engels, Eric A. / Bone morphogenetic protein use and cancer risk among patients undergoing lumbar arthrodesis a case-cohort study using the SEER-medicare database. In: Journal of Bone and Joint Surgery - American Volume. 2016 ; Vol. 98, No. 13. pp. 1064-1072.
@article{ad065f6195204998bd008d835d486157,
title = "Bone morphogenetic protein use and cancer risk among patients undergoing lumbar arthrodesis a case-cohort study using the SEER-medicare database",
abstract = "Background: Recombinant bone morphogenetic proteins (BMPs) are growth factors utilized in lumbar arthrodeses. Limited data from randomized trials suggest that BMP may increase cancer risk. We sought to evaluate cancer risk and mortality following the use of BMP in lumbar arthrodesis. Methods: Within the linked Surveillance, Epidemiology, and End Results (SEER) Program-Medicare cohort, we conducted a case-cohort study of 7,278 individuals who were ≥65 years of age and had undergone a lumbar arthrodesis from 2004 to 2011. Of these patients, 3,627 were individuals in a 5{\%} random subcohort of Medicare enrollees in SEER areas including 191 who developed cancer, and there were 3,651 individuals outside the subcohort who developed cancer. Weighted Cox proportional-hazards regression was used to estimate hazard ratios (HRs) and 95{\%} confidence intervals (95{\%} CIs) for cancer on the basis of exposure to BMP. Results: In the SEER-Medicare subcohort, 30.7{\%} of individuals who underwent a lumbar arthrodesis received BMP. BMP was not associated with overall cancer risk in univariate analyses (HR, 0.92 [95{\%} CI, 0.82 to 1.02]) or after adjustment for demographic characteristics, comorbidities, hospital size, history of cancer, and calendar year (adjusted HR, 0.94 [95{\%} CI, 0.84 to 1.05]). Individual cancer types were also not significantly elevated (p > 0.05 for all) in BMP users compared with nonusers. In addition, BMP use was not associated with a new cancer in people who had cancer prior to undergoing lumbar arthrodesis (adjusted HR, 1.04 [95{\%} CI, 0.71 to 1.52]) or withmortality after a cancer diagnosis (adjusted HR, 1.05 [95{\%} CI, 0.93 to 1.19]). Conclusions: In a large population of elderly U.S. adults undergoing lumbar arthrodesis, BMP use was not associated with cancer risk or mortality.",
author = "Beachler, {Daniel C.} and Yanik, {Elizabeth L.} and Martin, {Brook I.} and Pfeiffer, {Ruth M.} and Mirza, {Sohail K.} and Deyo, {Richard (Rick)} and Engels, {Eric A.}",
year = "2016",
month = "7",
day = "6",
doi = "10.2106/JBJS.15.01106",
language = "English (US)",
volume = "98",
pages = "1064--1072",
journal = "Journal of Bone and Joint Surgery - American Volume",
issn = "0021-9355",
publisher = "Journal of Bone and Joint Surgery Inc.",
number = "13",

}

TY - JOUR

T1 - Bone morphogenetic protein use and cancer risk among patients undergoing lumbar arthrodesis a case-cohort study using the SEER-medicare database

AU - Beachler, Daniel C.

AU - Yanik, Elizabeth L.

AU - Martin, Brook I.

AU - Pfeiffer, Ruth M.

AU - Mirza, Sohail K.

AU - Deyo, Richard (Rick)

AU - Engels, Eric A.

PY - 2016/7/6

Y1 - 2016/7/6

N2 - Background: Recombinant bone morphogenetic proteins (BMPs) are growth factors utilized in lumbar arthrodeses. Limited data from randomized trials suggest that BMP may increase cancer risk. We sought to evaluate cancer risk and mortality following the use of BMP in lumbar arthrodesis. Methods: Within the linked Surveillance, Epidemiology, and End Results (SEER) Program-Medicare cohort, we conducted a case-cohort study of 7,278 individuals who were ≥65 years of age and had undergone a lumbar arthrodesis from 2004 to 2011. Of these patients, 3,627 were individuals in a 5% random subcohort of Medicare enrollees in SEER areas including 191 who developed cancer, and there were 3,651 individuals outside the subcohort who developed cancer. Weighted Cox proportional-hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for cancer on the basis of exposure to BMP. Results: In the SEER-Medicare subcohort, 30.7% of individuals who underwent a lumbar arthrodesis received BMP. BMP was not associated with overall cancer risk in univariate analyses (HR, 0.92 [95% CI, 0.82 to 1.02]) or after adjustment for demographic characteristics, comorbidities, hospital size, history of cancer, and calendar year (adjusted HR, 0.94 [95% CI, 0.84 to 1.05]). Individual cancer types were also not significantly elevated (p > 0.05 for all) in BMP users compared with nonusers. In addition, BMP use was not associated with a new cancer in people who had cancer prior to undergoing lumbar arthrodesis (adjusted HR, 1.04 [95% CI, 0.71 to 1.52]) or withmortality after a cancer diagnosis (adjusted HR, 1.05 [95% CI, 0.93 to 1.19]). Conclusions: In a large population of elderly U.S. adults undergoing lumbar arthrodesis, BMP use was not associated with cancer risk or mortality.

AB - Background: Recombinant bone morphogenetic proteins (BMPs) are growth factors utilized in lumbar arthrodeses. Limited data from randomized trials suggest that BMP may increase cancer risk. We sought to evaluate cancer risk and mortality following the use of BMP in lumbar arthrodesis. Methods: Within the linked Surveillance, Epidemiology, and End Results (SEER) Program-Medicare cohort, we conducted a case-cohort study of 7,278 individuals who were ≥65 years of age and had undergone a lumbar arthrodesis from 2004 to 2011. Of these patients, 3,627 were individuals in a 5% random subcohort of Medicare enrollees in SEER areas including 191 who developed cancer, and there were 3,651 individuals outside the subcohort who developed cancer. Weighted Cox proportional-hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for cancer on the basis of exposure to BMP. Results: In the SEER-Medicare subcohort, 30.7% of individuals who underwent a lumbar arthrodesis received BMP. BMP was not associated with overall cancer risk in univariate analyses (HR, 0.92 [95% CI, 0.82 to 1.02]) or after adjustment for demographic characteristics, comorbidities, hospital size, history of cancer, and calendar year (adjusted HR, 0.94 [95% CI, 0.84 to 1.05]). Individual cancer types were also not significantly elevated (p > 0.05 for all) in BMP users compared with nonusers. In addition, BMP use was not associated with a new cancer in people who had cancer prior to undergoing lumbar arthrodesis (adjusted HR, 1.04 [95% CI, 0.71 to 1.52]) or withmortality after a cancer diagnosis (adjusted HR, 1.05 [95% CI, 0.93 to 1.19]). Conclusions: In a large population of elderly U.S. adults undergoing lumbar arthrodesis, BMP use was not associated with cancer risk or mortality.

UR - http://www.scopus.com/inward/record.url?scp=84984686665&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84984686665&partnerID=8YFLogxK

U2 - 10.2106/JBJS.15.01106

DO - 10.2106/JBJS.15.01106

M3 - Article

VL - 98

SP - 1064

EP - 1072

JO - Journal of Bone and Joint Surgery - American Volume

JF - Journal of Bone and Joint Surgery - American Volume

SN - 0021-9355

IS - 13

ER -