Background: Vertebral compression fractures (VCFs) are associated with reduced gait ability and functional impairment in older adults. Factors related to walking aid use at discharge remain unclear. This study examined associations between walking aid use and physical function at discharge. Methods: This cross-sectional study included 143 patients with VCFs discharged from Kurume Rehabilitation Hospital. Participants were classified into independent ambulation and walking aid groups, the latter subdivided into cane and walker users. Pain, cognitive function, handgrip strength, 30-second chair stand test, Berg Balance Scale (BBS), and skeletal muscle mass index (SMI) were assessed at discharge. Logistic regression identified factors associated with walking aid use, and exploratory analysis compared cane and walker users. Receiver operating characteristic (ROC) analysis was used to determine the BBS cutoff. Results: BBS at discharge was significantly associated with walking aid use (odds ratio [OR]=0.85; 95% confidence interval [CI] 0.77–0.93; p<0.001). In exploratory analysis, pain (OR=1.43; 95% CI 1.03–1.96; p=0.029) and SMI (OR=0.40; 95% CI 0.20–0.79; p=0.010) were associated with cane versus walker use. The optimal BBS cutoff was 48.5 (area under the curve [AUC]=0.83). Conclusion BBS was associated with the distinction between independent ambulation and walking aid use, while pain and SMI were associated with differences among walking aid users. These findings may inform clinical decision-making for walking aid selection at discharge.