We report a case of an 86-year-old woman with intractable low back and buttock pain. Radiography revealed multilevel osteoporotic vertebral compression fractures (VCFs) of the thoracolumbar spine. Magnetic resonance imaging demonstrated L2 and L3 VCFs with vacuum cleft and the incidental finding of sacral insufficiency fracture (SIF) at S1. Concomitant percutaneous vertebroplasty and sacroplasty were performed for multilevel osteoporotic VCFs and SIF in a single-stage procedure under local anesthesia. Postoperative radiography revealed good augmentation of bone cement at L2, L3, and S1. The patient was satisfied with the dramatic pain relief and good recovery of daily activities.