Chauhan, RohilToor, AmanjeetSegar, Anand2025-08-292025-08-292025-08-29New Zealand Medical Journal, ISSN: 1175-8716 (Online), Pasifika Medical Association Group, 138(1621), 106-109. doi: 10.26635/6965.70661175-8716http://hdl.handle.net/10292/19737Lower back and buttock pain in older adults is often attributed to lumbar or hip degenerative pathology.1 However, in patients with multimorbidity, particularly those with malignancy or osteoporosis, broader causes must be considered. We present a 71-year-old female with three episodes of intractable, alternating buttock pain over 12 months, diagnosed with bilateral sacral insufficiency fractures (SIFs) upon orthopaedic consultation. This case illustrates the diagnostic challenge of SIFs and the importance of multidisciplinary management in fragility fracture care.Open Access. The NZMJ offers free open access for all individuals that subscribe to the journal. The NZMJ is fully available to individual subscribers and does not incur a subscription fee.11 Medical and Health SciencesGeneral & Internal Medicine32 Biomedical and clinical sciences42 Health sciencesEndocrinologyFragility fracturesOrthopaedicsRadiologySacral insufficiency fractureJournal ArticleOpenAccess10.26635/6965.7066