Osteoporosis is a serious health problem worldwide and leads to a significant burden on society. Unfortunately, efforts to control osteoporosis are largely unsuccessful. Lowering an individual's risk for osteoporosis must focus not only on treatment but also on modification of risk factors. One of the common risk factors is smoking tobacco. Here, we review the clinical evidence on nicotine consumption and osteoporosis, and propose a possible protective mechanism. It should be note that there is no strong clinical evidence that proves nicotine is detrimental. Studies also indicated that the prime criminal for osteoporosis is smoking not nicotine. Moreover, low level nicotine has preventive efforts on osteoporosis by stimulating osteoblasts proliferation and differentiation. We present a hypothesis that low level nicotine may be a novel approach to reduce osteoporosis incidence.