Appendix Table 2.

Osteoporotic Fracture Outcomes Reference Guide^*

Fracture Outcome	Fracture Location	Definition	Example
Clinical†	Any fracture	Anyfracture (vertebral or nonvertebral) discovered because the patient is symptommatic; verified by radiograph‡	A patient seeks care for symptoms that are suggestive of fracture after a fall from a standing height, and the clinician orders radiographs by which the fracture is subsequently confirmed.
Clinical vertebral	Spine	A vertebral fracture discovered because the patient is symptomatic; verified by radiograph	After a fall from a standing height, a patient seeks care dueto symptoms highly suggestive of vertebral fracture, and the clinician orders radiographs confirming fracture.
Nonvertebral†	All nonspine	Clinical fractures outside the spine§, excludeing fractures not considered to be related to osteoporosis (e.g., in the toes, skull, face, or fingers)	A patient breaks their tibia during a fall from a standing height, and fracture is subsequently confirmed by radiograph.
Hip	Hip	Clinical fracture at the top of the femur	A patient falls and cannot get up due to hip pain. Hip fracture is subsequently confirmed by radiograph.
Radiographic vertebral	Spine	Anyvertebral fracture appearing on a radiography∥, regardless of whether the patient is symptomatic	A study performs spinal radiographs on all participants entering the study and again after treatment.

^*Most studies limited data to fragility fractures (i.e., fractures resulting from a fall from a standing height or lower) and radiographic vertebral fractures; pathologic and high-trauma fractures were generally excluded. A combined outcome of any clinical fracture was created specifically for the network meta-analysis (34).

^†Not a GRADE (Grading of Recommendations Assessment, Development and Evaluation) outcome, but analyzed as any clinical fracture for network meta-analysis.

^‡Major osteoporotic fractures (fractures of hip, spine [clinical], wrist, or humerus) were included as any clinical fracture.

^§Several studies limited nonvertebral fractures to predetermined sites. For example, the MOVER (MOnthly intraVenous ibandronatE versus daily oral Risedronate) study defined nonvertebral fractures as those at 6 major sites: the femur, the forearm, the humerus, the clavicle, the tibia/fibula, and the pelvis (94).

^ǁMost studies used semiquantitative and/or quantitative morphometry assessment to determine prevalent and incident vertebral fractures.