Background and Objectives: Osteoporosis risk in real-world, outpatient settings is shaped by intersecting socio-demographic, environmental, and clinical factors. We evaluated predictors of fracture risk status among adults seeking care in community pharmacies in Lahore, Pakistan. Materials and Methods: We conducted a cross-sectional study across urban and suburban pharmacies using a validated questionnaire aligned with international guidelines. Participants were classified as lower risk (osteopenia/osteoporosis without fragility fracture) or high risk (≥1 fragility fracture with clinical osteoporosis). Associations between candidate factors and risk status were examined using univariate and multivariable logistic regression analyses. Results: Of 286 participants, 53.1% were classified as lower risk. After adjustment, most sociodemographic characteristics were not independently associated with fracture risk status, except monthly income. Strong associations were observed for diabetes (AOR = 0.005, 95% CI 0.0007–0.040; p < 0.001), short-term glucocorticoid use (AOR = 32.33; p = 0.004), current smoking (AOR = 14.23; p = 0.002), ex-smoking (AOR = 4.95; p = 0.042), and lack of sunlight exposure (AOR = 7.09; p = 0.019). CKD, rheumatoid arthritis, and vitamin D insufficiency demonstrated borderline non-significant trends. Multivariable modeling did not include “not tested” categories or sparse variables. Conclusions: In Lahore’s community pharmacies, diabetes, CKD, RA, glucocorticoid exposure, smoking, and sunlight/vitamin D-related factors were the dominant correlates of osteoporosis fracture risk status, whereas most socio-demographic factors exerted limited independent effects. Pharmacy-anchored screening and counseling focused on these high-yield clinical indicators alongside timely BMD referral and guideline-concordant therapy may help identify individuals at elevated fracture risk.