Employing twisted forms in tall buildings is a relatively new architectural phenomenon, as are the cases with the Chicago Spire and Shanghai Tower. These super-tall buildings employ outrigger structures as their primary lateral load resisting systems. This paper presents structural performance of outrigger structures employed for twisted towers. Twisted tall buildings of different twisted rates are designed with outrigger structures. Two cases are studied comparatively. The first case uses spirally slanted perimeter mega-columns in response to the twisted building form. The second case uses vertical mega-columns, set back from the building perimeter, and cantilevered floor slabs from the column lines. The comparative structural efficiency of these cases is presented.