Objective: Multiple myeloma (MM) is characterized by the accumulation of monoclonal plasma cells and osteolytic bone destruction and is complicated by skeletal-related events (SREs) which are associated with significant morbidity. We conducted a retrospective analysis of US health insurance claims to examine the cost of SREs among patients with MM and at least one SRE. Methods: Data were obtained from i3's Lab Rx Database from May 1, 2000 to May 31, 2005. Patients were included if they had at least 2 ICD-9 diagnoses of MM (ICD-9 203.0x); and at least 1 SRE on or after the initial MM diagnosis. SREs were defined as a pathological fracture, spinal cord compression, surgery to the bone, or radiation to the bone and were identified using ICD-9 and CPT-4 codes. Patients had be continuously insured for at least six months prior to their first SRE (index date) and one month after their index date. Descriptive statistics were calculated and annual cost of SREs was estimated using Kaplan-Meier curves to adjust for censoring. Results: In the study period, 876 patients were diagnosed with MM, and 429 (49%) experienced at least 1 incident SRE. The mean time from MM diagnosis to index SRE was 259 days. Pathological fracture (60%) and radiation therapy (59%) were the most frequently experienced SREs followed by surgery to the bone (23%). Among these patients, 61% had 1 type of SRE, 27% had 2 types of SREs and 12% had 3 or more. The mean charges associated with SREs in the 1 year post SRE was $20,285, with the highest charges associated with pathological fracture ($11,370), followed by bone surgery ($4,020), and radiation therapy ($2,966). Conclusion: This analysis of patients with MM revealed that the incidence of SREs is high and their annual economic impact is substantial.