Objective: To analyze a nationwide (here, US) population database of trends in bone morphogenetic protein (BMP) use in spinal fusion surgery between 2002-2011. Background: The off-indication (off-label) use of BMP in spinal surgery is unknown. The purpose of this study was to analyze a population database to understand the probability, demographics, costs, and mortality of BMP use nationwide. Methods: Data from the National Health Care Expenditure and Utilization Program inpatient sample database were sought for each year between 2002 and 2011. Patients undergoing anterior cervical fusion or posterior cervical fusion, anterior lumbar fusion or posterior lumbar fusion, or posterior thoracic fusion were identified and grouped for comparison. The frequency of BMP use in each group was analyzed for each year. Patient demographic characteristics, hospital parameters, costs, and mortality were calculated. Results: The number of BMPs used per year increased from 1,116 in 2002 to 79,294 in 2011, accounting for approximately 26.9% of all spinal fusion procedures. the rate of BMP use increased significantly in all groups over the 10-year period (p < 0.001). Posterior lumbar fusion was the most used spinal fusion procedure, accounting for 76.8% of all spinal fusions performed between 2002 and 2011. The use of BMP in anterior cervical fusion peaked at 10.6% in 2007 and then decreased to 6.4% in 2011. Complications with BMP use increased significantly in elderly patients during this period. Hospitalization costs increased significantly by $9,560 between 2002 and 2010 (excluding inflation). There was no significant change in the number of days patients were hospitalized or mortality during this period. Conclusion: This study shows a dramatic increase in the use of BMP between 2002 and 2011. Interestingly, off-label indication use accounted for the vast majority of BMP use. The increase in total hospital cost was multifactorial; increased complications of surgery in elderly patients and increased BMP use were possible factors. days in hospital and mortality did not increase significantly over the 10-year period.