Sacral insufficiency fracture (SIF) is not uncommon, especially in the elderly, and is associated with a significant decrease in quality of life. SIF is most frequently found in patients with sacroiliac joint pathology in the setting of a sacrum compromised due to conditions such as osteoporosis, rheumatoid arthritis, or radiation therapy. Nonspecific symptoms of SIF make diagnosis challenging. MRI is the gold standard for diagnosis of SIF. Traditional therapies revolved around conservative measures such as bed rest, physical therapy, and analgesia. Conservative management is safe; minimally invasive treatments such as sacroplasty may provide improved short- and long-term relief. Surgical management with screw fixation is a viable option for qualifying patients and can be offered in conjunction with cement augmentation.

Institutional investors channel savings to investments. The chapter looks at banks, insurers and pension funds, and their ability to foster sustainability. Their investment decisions have a crucial role in either making some activities possible or others not. Different institutional institutions, depending on their individual characteristics, operate under different sets of prudential regulation, tailored to their specifics. There is a topical debate on how prudential supervision is best used to foster sustainable investment. The alternative approaches are either a neutral risk-based approach, or one that either incentivises sustainable investments through lower capital charges or penalises ‘brown’ ones through higher charges. Different stakeholders have different thoughts on the best approach, with supervisors generally supporting an orthodox risk-based approach and the investors, while generally supporting the risk-based approach, having some reservations on the issue.The conclusion will be that the risk-based approach will be the sustainable financial approach. After all, rather just a climate catastrophe instead of a climate catastrophe connected to a financial catastrophe.