Sacral insufficiency fracture (SIF) is a type of stress fracture that occurs primarily in elderly women. SIFs generally present as non-specific pelvic or low back pain and are often overlooked. SIFs are secondary to a number of conditions including postmenopausal osteoporosis, steroid-induced osteoporosis and radiation therapy. SIFs generally occur in patients who have sustained minimal or no trauma. SIF should be considered in elderly women with low back pain. We presented here an old woman with SIF who was treated with salmon calcitonin and physical therapy procedures successfully.