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Objective: Cigarette smoking harms all body systems, and its effects are primarily related to nicotine. However, the heavy metal content (mainly lead and cadmium) could add to nicotine's hazardous effects. Thus, the current study aimed to investigate the effect of cigarette smoking content of cadmium and lead on bone mineral density. Subjects and Methods: A retrospective analysis of data from active, passive, and non-smokers (every 70 subjects) was analyzed for patient demographics, laboratory investigation, serum cotinine (as a confirmatory marker of smoking, bone mineral density (BMD), blood and urinary levels of cadmium and lead). Results: Hemoglobin concentrations and red blood cell count were significantly reduced, while erythrocyte sedimentation rate and liver enzymes were significantly increased in active and passive smokers than non-smokers. Serum cadmium, lead, and cotinine were raised considerably in passive and active than non-smokers (0.47±0.05, 21.94±3.99, 5.35±0.90 in active, 0.32±0.09, 18.91±3.30, and 4.35±0.89 in passive, versus 0.09±0.06, 9.84±2.63, and 1.28±0.21 in the control group, successively). Bone mineral density was reduced in active and passive than non-smokers at the radial shaft, femoral neck, and spine. Cotinine was significantly and proportionately correlated with serum cadmium and lead and inversely correlated with bone mineral density. Furthermore, cadmium and lead were inversely correlated with BMD. Conclusion: Cigarettesmoke was associated with higher concentrations of cadmium, and lead may directly and indirectly share in the harmful effects of smoking on BMD. Keywords: Bone Mineral Density, Cotinine, Toxic Heavy Metals, Smoking