Silk fibroin has garnered significant attention as a natural biomaterial due to its exceptional biocompatibility, tunable water solubility, optical transparency and high thermal stability. In recent years, silk fibroin films have gained prominence for their ease of fabrication and unique properties. However, their intrinsic brittleness limits broader applicability in certain fields. To overcome this challenge, researchers have developed various strategies, including physical blending, chemical modification, and genetic engineering, to improve key attributes such as mechanical strength, antimicrobial activity, and electrical conductivity. These advancements have significantly broadened the utility of silk fibroin films in diverse biomedical applications. This review provides an in-depth analysis of recent progress in silk fibroin-based composite films, emphasizing their applications in bone regeneration, wound healing, and health monitoring. Modified silk fibroin composites are highlighted for their superior material properties and enhanced functional potential in these domains. Additionally, this review discusses future research directions, offering valuable insights into pathways for further innovation and practical implementation. With continued advancements, silk fibroin composite films are poised to make transformative contributions to the fields of biomedicine and biotechnology.