Objective:To investigate the association of osteosarcopenia with falls, risk of fracture, malnutrition among middle-aged and elderly adults.Methods:A total of 253 participants dwelling in Guangzhou community aged 40-90 years were included in this cross-sectional study from December 2017 to December 2019.Bone mineral density(BMD)was detected by dual-energy X-ray absorptiometry(DEXA). Body composition was analyzed by a bioelectrical impedance analysis.Handgrip strength and gait speed were examined.The 10-year probability of a major osteoporotic fracture and hip fracture were evaluated by online WHO fracture risk assessment tool( FRAX?). Results:According to diagnostic criteria of AWGS and EWGSOP2, the incidences of osteosarcopenia varied from 5.1% to 7.6%, 5.1% to 11.4% respectively.After the adjustment for age and gender, Logistic regression analysis showed that osteosarcopenia was correlated with falls, risk of fracture and malnutrition.Osteosarcopenia definited by AWGS criteria was strongly correlated with falls( OR=3.27-5.68, P<0.05), osteosarcopenia definited by non-severe sarcopenia criteria was strongly correlated with the risk of hip fracture( OR=1.14-1.15, P<0.05), and fat-free mass index was strongly correlated with osteosarcopenia with different definitions( OR=0.21-0.48, P<0.05). Conclusions:Osteosarcopenia is associated with higher risk of falls, fracture and malnutrition in the Guangzhou community-dwelling middle-aged and elderly adults, and fat-free mass index is an independent risk factor for osteosarcopenia.