The lateral aspect of the femurs are under tension, while the medial sides are more affected by compressive forces. Tension-sided stress fractures are more concerning because normal biomechanical forces do not facilitate apposition. Also, it is strange to get enough chronic stress on the distractive side of a bone to cause a stress fracture, as stress fractures usually occur at critical sites of chronic compressive stress. Because of this, an underlying etiology should be sought, as this is suggestive of an insufficiency type of stress fracture (vs overuse). Bisphosphonate therapy has a known association with these atypical stress-fracture patterns, and should be a primary consideration in elderly female patients.