Falling is a leading cause of severe injuries among the elderly, such as hip fracture. This study examined the regional and sex differences in fall-related physical fitness of the elderly between Seoul, Korea and Gifu, Japan. The study included 87 elderly residents of Seoul (mean age 75.4 years; 21 males and 66 females) and 91 elderly residents of Gifu (mean age 71.9 years; 17 males and 74 females). The participants underwent various physical tests, and two-way ANCOVA (region × sex) with age as a covariate was used for statistical analysis. Significant interaction was shown by the one-legged stance (OLS) with eyes open test, which was higher in elderly females from Gifu than in those from Seoul. Significant main effects for the region were shown by the 30-s chair stand (CS-30) and reaction time tests, wherein the Gifu group performed better than the Seoul group. Significant main effects for sex were shown by the sit and reach, handgrip strength, and knee extension strength tests, which were higher for females in the sit and reach test and lower for females in the handgrip and knee extension strength tests compared to the corresponding males in both the cases. Lastly, elderly from Gifu performed better than those from Seoul in the reaction time, CS-30, and OLS tests. Since the ability to move quickly and maintain balance to avoid falling are factors necessary for reducing fall risk, fall prevention classes and exercise programs are required to improve these abilities in the elderly.