Aim Frailty is a highly prevalent geriatric syndrome, characterized by increased vulnerability to subsequent morbidity and mortality. The association between frailty and preclinical atherosclerosis remains uncertain. The aim of the present study was to clarify the relationship between frailty, preclinical atherosclerosis and inflammatory markers in older adults. Methods We enrolled 1798 inhabitants of I‐Lan County of Taiwan (855 men, 47.5%; mean age 64 ± 9 years, range 50–92 years). Assessment of frailty was based on the Cardiovascular Health Study criteria. Common carotid artery intima‐media thickness (CIMT) was determined using carotid Doppler ultrasonography. Results Overall, 955 participants (53.1%) were non‐frail, 724 (40.2%) were pre‐frail and 119 (6.7%) were frail. Frail and pre‐frail participants had significantly increased CIMT, high‐sensitivity C‐reactive protein, glycated hemoglobin and urine albumin‐to‐creatinine ratio, but had lower insulin‐like growth factor‐1 level and decreased femoral neck bone mineral density (BMD). By multivariate analysis, age (OR 2.53, 95% CI 1.92–3.33), C‐reactive protein (OR 1.19, 95% CI 1.00–1.42), CIMT (OR 1.27, 95% CI 1.04–1.55) and femoral neck BMD (OR 0.49, 95% CI 0.38–0.65) were independently associated with frailty. Conclusions The present study showed the epidemiology of frailty, and the strong connection to aging, increased CIMT, enhanced inflammation and decreased femoral neck BMD. These results suggested that preclinical atherosclerosis, inflammation and femoral neck BMD were potentially modifiable risk factors for frailty. Geriatr Gerontol Int 2017; ••: ••–••.