Objectives The aim of this study was to compare muscle quality (MQ) between octogenarians classified as non-fallers, fallers and recurrent fallers and identify confounding intrinsic and extrensic factors that impact likelihood for falls. Design This observational, descriptive, cross-sectional study included older adults (N=220) aged 80 years or older. Measurements The Short Physical Performance Battery (SPPB) was used to evaluate physical function and MQ was calculated using the ratio of grip strength to arm muscle mass (in kilograms) quantified by DXA. Variables related to sociodemographic, clinical, cognitive function, and falls were evaluated using a questionnaire and symptoms of depression were evaluated by the Geriatric Depression Scale (GDS). A Kruskal-Wallis H test was used to verify differences between groups. Binomial logistic regression was performed to determine the impact of age, depression, polypharmacy, balance, MQ, and sex on participants having more than four falls in their history. Results Increasing MQ was associated with reduced likelihood of more than four falls in their history. Non-fallers were statistically younger (p = 0.012) and took more medications (p = 0.023) than recurrent fallers. Recurrent fallers had lower MQ when compared with fallers (p = 0.007) and non-fallers (p = 0.001) and had a lower GDS score when compared with fallers (p = 0.022). Finally, fallers presented lower scores for balance when compared to non-fallers (p = 0.013). Conclusion A higher MQ is associated with a reduction in the likelihood falls in octogenarians. Therefore, it may be advantageous for clinicians to evaluate MQ when the screening of the risk of falls in older adults.