Osteoporosis is a silent, progressive condition; however, it can be prevented and managed. The assessment of 10-year fracture risk can predict long-term osteoporotic fracture risk. This study was designed to examine osteoporotic fracture risk, its associated factors, and related knowledge among Egyptian adults aged 40+ from the 1st of April 2025 to the 1st of July 2025. This national survey included 2,242 participants over 40 years old from different regions in Egypt, using a questionnaire with five parts, including the OKAT questionnaire and the online FRAX tool, which was filled out by an interviewer. The mean age of participants was 50.6 years, ranging from 40 to 90 years, and the mean BMI was 29.9 (± 5.6) kg/m². 2% and 4.1% were at high risk for major and hip fractures, respectively. The risk of hip and major osteoporotic fractures was significantly associated with long-term cortisone use, smoking, how long someone has smoked, higher consumption of soft or energy drinks, as well as early menopause and using hormonal contraceptives among the women in the study. 58.7% had a poor knowledge level. The OKAT score showed a negative correlation with fracture risks, significant only for hip fracture (p = 0.007). A strong positive correlation was found between major and hip fracture risks. Most studied adult Egyptian participants had significant knowledge gaps and misconceptions, a high prevalence of risk factors, and inadequate preventive practices. Therefore, it is important to emphasize the necessity for targeted educational interventions and screening through reliable sources to reduce the future burden of osteoporosis.