Abstract: Objective To investigate the association between oral frailty and the severity of osteoporosis in elderly women, identify the risk threshold of oral frailty for osteoporosis, and provide evidence for joint assessment in patients seeking care at primary healthcare institutions. Methods A cross-sectional study was conducted using convenience sampling. A total of 215 women aged ≥60 years who visited the Yuetan Community health service centers were enrolled. Bone mineral density(BMD) was measured by dual-energy X-ray absorptiometry(DXA),and participants were classified into three groups according to T-scores: normal bone mass,osteopenia,and osteoporosis. Oral frailty was assessed using the Oral Frailty Index-8(OFI-8) and categorized into low-risk(0-2 points),moderate-risk (3 points),and high-risk(≥4 points) groups. Spearman correlation analysis,Mantel-Haenszel linear trend test,and ordinal logistic regression were performed to analyze the association,adjusting for age,BMI,and monthly income. The proportional odds assumption was verified by the parallel lines test prior to regression modeling. Results Oral frailty grouping was positively correlated with BMD diagnostic grouping(r=0.226,P=0.001),and a significant graded association trend was observed(χ²=9.682,P=0.002). After adjusting for confounders,the high-risk oral frailty group(OFI-8 ≥4) was independently associated with greater severity of osteoporosis(OR=2.126, P=0.018),whereas the moderate-risk group showed no significant association(OR=0.669, P=0.266),suggesting that ≥4 points may serve as a screening cutoff for functional impairment.BMI was independently and negatively associated with osteoporosis severity(OR=0.892, P=0.005).Age(OR=1.051, P=0.026) and low income(OR=3.857, P=0.038) were independently and positively associated with osteoporosis severity. The parallel lines test was nonsignificant(χ²=9.696, df=6, P=0.138),confirming that the proportional odds assumption was satisfied. Conclusions Among elderly women visiting primary healthcare institutions,oral frailty demonstrates a graded association trend with osteoporosis severity. An OFI-8 score of ≥4 may be used as a screening cutoff for identifying high-risk populations for osteoporosis.

Key words: oral frailty, osteoporosis, elderly women, dual-energy X-ray absorptiometry