Purpose <p>Anorexia Nervosa can have a major impact on bone health through low bone mass and bone loss. Considering the lack of consensual guidelines for the prevention and treatment of bone loss in this condition, a systematic review was performed to provide practical treatment guidance for clinicians.</p> Methods <p>We systematically searched Medline, Cochrane, Psychinfo, and the Web of Science for anorexia nervosa AND (osteopenia OR osteoporosis OR bone density OR bone loss) AND (prevention OR treatment OR medication OR therapeutic) in clinical studies from March 1st, 2017, to October 31st, 2024, and included the last systematic review on the subject. We excluded reviews, editorials, unfinished trials, expert opinions, book chapters, and case reports. This research followed the PRISMA guidelines.</p> Results <p>A total of 27 publications were included in this review. The main outcome measured was spinal bone mineral density (BMD). Among 1932 participants (all female), 1439 had AN and the remainder were healthy controls. Monotherapies mostly included various hormonal replacement therapies and bisphosphonates. Combination trials were performed on small numbers or with a modest time range or effect size. Results were statistically significant in 15 studies. Estrogen replacement therapy, bisphosphonates, teriparatide and denosumab showed the most significant effects.</p> Conclusions <p>These results and our clinical experience in the field allowed us to formulate a treatment algorithm for managing bone loss in patients with anorexia nervosa according to their BMD and pubertal status.</p> <i>Level of evidence</i> <p>Level I, systematic review</p>