With the rapid development of China’s mineral industry, the emission of iron tailings sand has increased sharply. At present, the negative storage and landfill are still the main treatment methods, which does not only occupy a large amount of land resources, but also cause serious environmental pollution. Therefore, large-scale consumption of iron tailings sand is imminent. Iron tailings sand is a kind of waste discharged after the ‘useful part’ of iron ore is selected by grinding, flotation or magnetic separation under a certain condition. Compared with natural fine aggregate, the particle is finer, angular and more solid, which could be widely used in various practical projects. Among them, the regional differences of iron tailings, raw ore composition, grade, particle size and mining beneficiation refining process have a greater impact on the physical and chemical properties. As an inert material, different activation methods could be conducted to improve the activity of iron tailings sand, whereas, the composite activation is the most effective technology. In this paper, the utilization of building materials of iron tailings sand at home and abroad and its application in other fields are reviewed. The influence of concrete prepared by iron tailings sand on mechanical properties and durability is summarized. The key properties of the application in road functional materials are discussed. The application status of iron tailings sand-based bricks is sorted out. The feasibility of using it to prepare geopolymer is evaluated. Its advantages in the preparation of mesoporous molecular sieves and the improvement of expansive soil are discussed.