|We reviewed radiographs of 5,342 Swedish patients >55 years with a fracture of the femoral shaft in 2008-2010, and found 172 atypical fractures (AF). We obtained data on medication and comorbidity. The age-adjusted relative risk (RR) of AF associated with bisphosphonate use was 55 in women and 54 in men. In bisphosphonate users, women had a 3-fold higher risk than men. Alendronate users had higher risk than risedronate users. The RR after 4 years or more of use reached 126, with a corresponding absolute risk of 11 fractures / 10,000 person-years of use. The risk decreased 70% / year since last use.