Osteoporosis was one of degenerative disease that is common in the elderly. There was a several of risk factors of osteoporosis. Two of them were physical activity and smoking habits. Attitude was one part of a person’s behavior that may affect the prevention of disease. This study aimed to analyze the affect of physical activity, smoking habits, and attitude of the elderly to incidence of osteoporosis. This study is an observational study with case control design. The number of samples in this study was 66 elderly who visited Osteoporosis Clinic Husada Utama Hospital in Surabaya. Respondent selection taken with systematic random sampling. The independent variables of this study were physical activity, smoking habit, and attitude, while the dependent variable was incidence of osteoporosis. Based on correlation analysis with logistic regression test showed there was a significant correlation (p<0,05) between physical activity, smoking habits, and attitude. Odds Ratio (OR) in this study for physical activity was 14,764 ,smoking habit was 9,646 and attitude was 5,623. The conclusion of this study, there was physical activity as a dominant affect after controlled smoking habits and attitude to incidence of osteoporosis. The suggestion is to do physical activity three times a week, consume healthy food and beverage, take an enough sleep,reduce stress factors and stop smoking also.   Keywords: Physical activity, smoking habits, elderly