Osteoporotic fractures of the sacrum usually involve the sacral ala and can be managed with percutaneous cementoplasty if conservative therapy failed to achieve bone consolidation. On the other hand, isolated transverse fractures of the lowest sacrum are more rare, with little literature focusing on their management in the osteoporotic population. If pseudoarthrosis occurs in this location, sacroplasty is not an optimal therapeutic option because of the poor biomechanical resistance of cement to multi-directional stresses. Hence, we report two cases of chronic unhealed transverse fractures of the lowest sacrum successfully managed with percutaneous image-guided screw fixation augmented with cement injection. At last follow-up available, both patients experienced complete pain relief, without evidences of failure of the osteosynthesis on CT-scan controls.