Objectives The external morphology of the sacrum is demonstrably informative regarding tail type (i.e., tail presence/absence, length, and prehensility) in living and extinct primates. However, little research has focused on the relationship between tail type and internal sacral morphology, a potentially important source of functional information when fossil sacra are incomplete. Here, we determine if cortical bone cross‐sectional thickness of the last sacral vertebral body differs among tail types in extant primates and can be used to reconstruct tail types in extinct primates. Materials and Methods Cortical bone cross‐sectional thickness in the last sacral vertebral body was measured from high‐resolution CT scans belonging to 20 extant primate species (N = 72) assigned to tail type categories (“tailless,” “nonprehensile short‐tailed,” “nonprehensile long‐tailed,” and “prehensile‐tailed”). The extant dataset was then used to reconstruct the tail types for four extinct primate species. Results Tailless primates had significantly thinner cortical bone than tail‐bearing primates. Nonprehensile short‐tailed primates had significantly thinner cortical bone than nonprehensile long‐tailed primates. Cortical bone cross‐sectional thickness did not distinguish between prehensile‐tailed and nonprehensile long‐tailed taxa. Results are strongly influenced by phylogeny. Corroborating previous studies, Epipliopithecus vindobonensis was reconstructed as tailless, Archaeolemur edwardsi as long‐tailed, Megaladapis grandidieri as nonprehensile short‐tailed, and Palaeopropithecus kelyus as nonprehensile short‐tailed or tailless. Conclusions Results indicate that, in the context of phylogenetic clade, measures of cortical bone cross‐sectional thickness can be used to allocate extinct primate species to tail type categories.