BACKGROUND: Globally, Musculoskeletal disorders (MSDs) are the biggest contributor (17%) to years lived with disability. For offering diagnosis and appropriate health interventions options along with follow-up care, it is pertinent to have a thorough awareness of its associated risk factors. OBJECTIVES: The study aims to assess the prevalence and association between MSDs and risk factors among the Indian older adults above 45 years. METHODOLOGY: Prevalence of MSDs among 28,436 participants was estimated using nationally representative survey on older Indian adults. Spatial distribution maps were created to display the magnitude of MSD prevalence at Indian sub-national level. Association between presence of MSDs and associated risk factors (such as occupation, employment duration, physical activity, BMI, diabetes, hypertension, tobacco usage, and alcohol consumption) was explored through Multivariate logistic regression. P-value <0.05 was considered as statistically significant. RESULTS: MSD was prevalent in over half of participants (53.5 (52.9-54.1)%), with more among females and in those aged >60 years (60.4 (59.3-61.4)%). Overall, joint pain (41.9 (41.3-41.4)%) was more common than back pain (32.6 (32.0-33.1)%). Prevalence was highest in Manipur (81.1 (77.9-83.9)%) and lowest in West Bengal (33.1 (30.7-35.5)%). MSD presence was positively associated with certain occupational groups, pre-obesity (BMI 25-29.9 Kg/m2), currently hypertensive, vigorous physical activity among overall population. Tobacco usage was positively associated, while alcohol consumption was linked to a lower occurrence of MSDs for 45-60 years age group. CONCLUSIONS: Customised policy interventions can be developed for specific age category of older Indian adults and musculoskeletal health can be improved by addressing modifiable risk factors such as physical inactivity, tobacco usage, avoiding workplace risks in occupations requiring manual labour as revealed by this study.