The principal challenge for bone therapy is to deliver an effective dose of therapeutic agent (for example antibiotic or anti-cancer drug) to the affected site within bone, while sparing other organs. The solution to this dilemma is to deliver drug locally within the bone; hence various surface/therapeutic modifications of the conventional bone implants have been suggested to achieve this. Implants composed of biocompatible materials and loaded with active therapeutics thus provide one possible option for effective bone therapy. This chapter showcases the challenges that an electrochemically nano-engineered bone implant based on titania nanotubes must overcome to survive and deliver therapeutics in conditions such as infections and cancer of bone. The fabrication of titania nanotubes, the therapeutic loading and release, ex-vivo and in vivo investigations; all are reviewed in terms of effectiveness for therapeutic action. Also discussed are the potential advances of titania nanotube technology and the future research directions to address additional clinical problems.