Fenestrated bone screws and inserts disposed therein are provided for the delivery of medicants to bone. The bone screws provide a method to strengthen or repair damaged bones, or to promote bony fusion, and in conjunction with the inserts, provide a method of delivering a continuous or regulated amount of medicant to a desired location within the bone such as a fracture interface. In one embodiment, the inserts are customized in size, shape, or configuration after the bone screw has been inserted into the patient.