As with most fractures associated with osteoporosis, the incidence of pelvic ring injuries in this population of patients is rising rapidly. Osteoporotic pelvic ring injuries are exceedingly different in their etiology, natural history, and treatment from the more recognizable patterns in young patients with high-energy pelvic ring injuries. Recognition of a potentially unstable fracture pattern, careful evaluation of the ambulatory and functional status of each patient before injury, and the potential pitfalls and benefits of operative versus nonoperative care are critical to the effective treatment.