Localized surface plasmon resonance (LSPR) biosensors, which enable nanoscale confinement and manipulation of light, offer the enhanced sensitivity and electromagnetic energy localization. The integration of LSPR with the fiber-optic technology has led to the development of compact and versatile sensors for miniaturization and remote sensing. This comprehensive review explores various sensor configurations, fiber types, and geometric shapes, highlighting their benefits in terms of sensitivity, integration, and performance improvement. Fabrication techniques such as focused non-chemical bonding strategies and self-assembly of nanoparticles are discussed, providing control over nanostructure morphology and enhancing sensor performance. Bio-applications of fiber-optic LSPR (FOLSPR) sensors are detailed, specifically in biomolecular interactions and analysis of proteins, pathogens and cells, nucleic acids (DNA and RNA), and other small molecules (organic compounds and heavy metal ions). Surface modification and detection schemes are emphasized for their potential for label-free and real-time biosensing. The challenges and prospects of FOLSPR sensors are addressed, including the developments in sensitivity, fabrication techniques, and measurement reliability. Integration with emerging technologies such as nanomaterials is highlighted as a promising direction for future research. Overall, this review provides insights into the advancements and potential applications of FOLSPR sensors, paving the way for sensitive and versatile optical biosensing platforms in various fields.