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Atypical femoral fracture: 5 case reports In a multi-centre, retrospective study following review of medical records and pharmacy database of 277 patients from May 2012 to June 2017, 5 patients [ages and sexes not stated] were described, who developed atypical femoral fracture (AFF) during treatment with denosumab for breast cancer or non small cell lung cancer (NSCLC). Additionally, prior use of zoledronic acid (4 patients) or alendronic acid (1 patient) was also as a risk factor for development of AFF [not all dosages stated; routes and durations of treatments to reactions onsets not stated]. Case No. 1: The patient, who was diagnosed with invasive ductal carcinoma of the left breast (pTxN1M0), underwent left mastectomy and axillary lymph node dissection. The patient initially received adjuvant chemotherapy followed by adjuvant hormone therapy for 3 years. Due to development of multiple bone metastases the patient further received zoledronic acid at 13 years after the initial diagnosis of breast cancer. At 16 years after the initial diagnosis, zoledronic acid was switched to denosumab 120mg monthly. After receiving 45 doses of denosumab, the patient had a fall, and was diagnosed with left AFF. X-ray revealed a right atypical femoral stress reaction, consistent with AFF. The patient was admitted and underwent intra-medullary nail surgery. The patient received the last dose of denosumab at 20 years after the initial diagnosis and the chemotherapy was continued until the cut-off date. Case No. 2: The patient, who was diagnosed with breast cancer, underwent partial resection of the right breast and axillary lymph node dissection. The patient initially received radiation therapy. At 9 years after the initial diagnosis, the patient underwent left mastectomy due to local recurrence in the left breast. Metastatic lesions were also noted, and the patient received zoledronic acid at 2 years after the second surgery. Zoledronic acid was switched to denosumab 120mg monthly. Afterwards, the patient experienced loss of balance and pain in the left hip, but hip X-ray revealed no abnormalities. The patient’s hip pain worsened. Radiographs of the left femur revealed thickening of the lateral cortex suggestive of atypical femoral stress reaction in the left femur, consistent with AFF. A diagnosis of left AFF was thus made. The patient was admitted and underwent a prophylactic surgery following 47 doses of denosumab at 18 years after the initial diagnosis. Denosumab was withdrawn and hormone therapy was continued. The patient died due to progression of the breast cancer at 20 years after the initial diagnosis. Case No. 3: The patient, who was diagnosed with invasive ductal carcinoma of the right breast (pT1N1M0), underwent partial resection of the right breast with axillary lymph node dissection. Tumour recurrence was detected at 10 years after the initial diagnosis, and the patient received radiation therapy. The patient was treated with zoledronic acid. Then, the patient started receiving denosumab 120mg monthly. At 15 years a