Atypical femur fractures (AFFs) are related to the use of bisphosphonates and often show delayed or non-healing.  After an AFF, bisphosphonates are usually discontinued. It is unclear if certain osteoporosis drugs can promote healing, while there is no guideline on how patients with high risk of fragility fractures should be treated after an AFF. We performed a systematic literature review to evaluate the effect of teriparatide, raloxifene and denosumab both on healing and occurrence of AFF. We considered complete and incomplete forms separately. Our search retrieved 910 references and we reviewed 69 papers. We found 34 case reports, 8 retrospective cohort studies and 3 prospective studies that reported the effect of teriparatide. Radiological healing occurred within 6 months of teriparatide use in 13 of 29 conservatively treated incomplete AFFs (45%), 9 of 10 incomplete AFFs with surgical intervention (90%) and 41 of 55 complete AFFs (75%). In 9 of 29 incomplete AFFs on conservative treatment (31%) no union was achieved after 12 months of teriparatide and 3 fractures (10%) had completion despite teriparatide use. New AFFs occurred in 6 patients during or after the use of teriparatide. AFF after denosumab was reported in 24 patients, including 14 patients treated for metastatic bone disease (57%) and 7 patients without bisphosphonate exposure (29%). Denosumab after AFF is associated with 1 recurrent incomplete AFF and 1 contralateral AFF in case reports. Eight patients had used raloxifene prior to AFF, including 1 bisphosphonate-naive patient. Two patients were reported on raloxifene after incomplete AFF with good follow-up, but both had had prior teriparatide. In conclusion, all current antiresorptive drugs appear to be associated with AFF. Teriparatide may have a beneficial effect on healing of surgically treated AFF, but it does not seem to prevent new AFF nor ensure healing of conservatively treated incomplete AFF. These results need to be interpreted with caution due to heterogeneity of studies and a lack of prospective, adequately powered, controlled trials