Introduction Pelvic osteoporotic fractures (POFs) are often associated with considerable morbidity and mortality, in addition to prolonged rehabilitation and high costs. The most common sites of POFs include the pubic rami and the sacrum. Combined pubic rami and sacral osteoporotic fractures (SOFs) have been reported previously with varying comments on the mechanism of injury and incidence. Purpose of the study To evaluate the mobility, discharge destination, presence of back pain and length of stay of patients who sustained combined pubic rami and SOFs and to identify the significance of this association. Methods We prospectively studied 67 patients with low-impact pubic rami and/or SOFs over 12 months. The patients were over 60 years of age and were assessed by the fracture liaison service. MR imaging or bone scan were done when there was back pain or lumbo-sacral tenderness. Results There were 54 (80.4%) female and 13 (19.6%) male patients and the average age was 87.5 years (range 65–96). The mean length of stay was 45 (±35) days. Mortality rate was 10.4%. There was a significant relationship between low back pain and the presence of sacral fracture. Patients with combined pubic rami and SOFs showed significantly longer length of stay than those with isolated pubic rami fractures. Conclusion We recommend considering the high association between SOFs and pubic rami fractures and the presence of back pain in planning the management of patients with POFs and their rehabilitation, which would potentially exhaust resources, due to their significantly increased length of stay and reduced mobility.