An approach to identify a hip T-score criterion to exclude persons with spinal cord injury at a high risk of fracture prior to prescribing powered exoskeletons for ambulation

Powered exoskeletons enable persons with spinal cord injury (SCI) to fully weight-bear and ambulate. However, this population exhibits rapid onset of osteoporosis making them at high risk of fracture, most commonly around the knee. Unlike assessing bone at the hip, there isn't a standard method to obtain bone mineral density (BMD) at the knee. A previous report indicated that 0.60g/cm² was the lower end of the range at the knee for persons with SCI who have not sustained a fracture. This study investigated a relationship between hip and knee measurements, and found that a hip T-score of -3.1 was found to correlate with 0.60g/cm² at the knee. This initial attempt in providing a hip value is not meant to be absolute, but as a guide in effort to exclude those at greatest risk of fragility fracture.