Understanding how the mammalian neocortex creates cognition largely depends on knowledge about large-scale cortical organization. Accumulated evidence has illuminated cortical substrates of cognition across the lifespan, but how topological properties of cortical networks support structure-function relationships in normal aging remains an open question. Here we investigate the role of connections (i.e., short/long and direct/indirect) and node properties (i.e., centrality and modularity) in predicting functional-structural connectivity coupling in healthy elderly subjects. Connectivity networks were derived from correlations of cortical thickness and cortical glucose consumption in resting state. Local-direct connections (i.e., nodes separated by less than 30 mm) and node modularity (i.e., a set of nodes highly interconnected within a topological community and sparsely interconnected with nodes from other modules) in the functional network were identified as the main determinants of coupling between cortical networks, suggesting that the structural network in aging is mainly constrained by functional topological properties involved in the segregation of information, likely due to aging-related deficits in functional integration. This hypothesis is supported by an enhanced connectivity between cortical regions of different resting-state networks involved in sensorimotor and memory functions in detrimental to associations between fronto-parietal regions supporting executive processes. Taken collectively, these findings open new avenues to identify aging-related failures in the anatomo-functional organization of the neocortical mantle, and might contribute to early detection of prevalent neurodegenerative conditions occurring in the late life. Hum Brain Mapp 35:2724–2740, 2014. © 2013 Wiley Periodicals, Inc.