Pelvic insufficiency fractures and stress fractures of the pelvis and femoral neck are common but often overlooked causes of pain in orthopedic practice. Although their mechanisms differ, both conditions can present with similar, nonspecific symptoms. Insufficiency fractures usually occur in elderly patients with osteoporosis. Stress fractures result from repeated mechanical loading, often in young and active individuals. In both fracture types, patients typically present with pain localized to the hip, groin, or lower back that worsens with activity and partially subsides with rest. Diagnosis can be difficult because early plain radiographs are often normal. Magnetic resonance imaging is the most sensitive method for early detection and shows bone marrow edema before a fracture line appears. Computed tomography is useful for evaluating the fracture pattern and for surgical planning. The stability of the pelvic ring is the main factor guiding treatment of pelvic insufficiency fractures. Stable fractures are usually treated conservatively. Unstable fractures often need surgical fixation. Pelvic stress fractures are also generally treated conservatively. In contrast, femoral neck stress fractures, especially tension-side fractures, have a low chance of healing without surgery and often require surgical treatment. Early diagnosis and proper management reduce complications and improve patient mobility and long-term outcomes. This review summarizes the epidemiology, risk factors, diagnosis, classification, and treatment of these conditions.