BONESUPPORT Starts 2026 on a Strong Note as U.S. Demand and Clinical Progress Support Expansion

BONESUPPORT Holding AB began 2026 with a solid first quarter, reporting stronger sales, higher earnings, and improved cash generation as demand for its CERAMENT product portfolio continued to build in the United States and other key markets. In the company’s interim report for the quarter ended March 31, 2026, net sales rose to SEK 324.0 million from SEK 283.5 million a year earlier, equal to 14% reported growth and 31% growth at constant exchange rates. Gross margin stayed high at 92.2%, while adjusted operating profit climbed to SEK 84.9 million from SEK 39.7 million. BONESUPPORT also reported operating cash flow of SEK 74.9 million and cash at period end of SEK 455.3 million, showing that revenue growth is increasingly translating into stronger profitability and liquidity.

A Quarter Defined by Commercial Momentum

The biggest driver behind the quarter was once again the U.S. market, where BONESUPPORT continues to deepen adoption of CERAMENT G across orthopedic use cases. The company said its U.S. segment posted sales growth of 16% on a reported basis and 35% at constant exchange rates. In the CEO statement, Torbjörn Sköld described the period as a “solid start to 2026,” adding that the company saw especially strong growth for CERAMENT G in the U.S. together with improved cash flow. According to the report, net sales of CERAMENT G in the United States reached SEK 222 million, marking the largest sequential quarterly growth ever measured in local currency, equivalent to USD 2.6 million. The company said adoption is spreading across Foot and Ankle, Trauma, and Arthroplasty, suggesting that surgeons are increasingly making the product part of routine treatment decisions rather than using it only in selected cases.

That detail matters because it shows BONESUPPORT is moving beyond early commercial rollout and into wider procedural integration. Management indicated that stronger clinical evidence, indication-specific surgical techniques, and disciplined market development are helping CERAMENT G gain inclusion in a growing number of care programs. In practical terms, this means the product appears to be benefiting not only from awareness, but from repeat use and institutional acceptance. For a medtech company focused on orthobiologics and infection management in bone surgery, that type of adoption curve can be especially important because long-term growth often depends on surgeon confidence, reimbursement clarity, and published outcomes data all developing together. BONESUPPORT’s first-quarter update suggests that those three pieces are becoming more aligned.

Europe and Rest of World Also Added Support

Although the U.S. remained the main growth engine, BONESUPPORT also reported continued progress in Europe and the Rest of the World, or EUROW. Sales in that segment rose 9% on a reported basis and 16% at constant exchange rates. Management said growth was supported across the company’s three operating structures: direct markets, hybrid markets, and distributor markets. The U.K. continued a recovery trend that had already become visible in the fourth quarter of 2025, while hybrid market investments also developed well. In distributor territories, CERAMENT was launched in India as planned, with an initial focus on the private market. BONESUPPORT said it views India as a market that can contribute positively to growth over the long term.

Still, the regional picture was not entirely free from risk. The company noted some uncertainty in the Middle East, where geopolitical unrest is affecting market presence and logistics in the short term. That comment adds a note of caution to an otherwise upbeat report. For international medical technology companies, logistics reliability, procedure volumes, and distributor access can all be sensitive to regional instability. BONESUPPORT did not quantify the impact, but its acknowledgment suggests management is monitoring those issues closely while continuing to push for broader geographic expansion. Even so, the overall message remained positive: demand trends outside the United States are healthy enough to support the group’s wider growth strategy.

Profitability Improved Sharply

One of the clearest signs of operating progress in the quarter was the increase in profitability. BONESUPPORT reported a gross profit of SEK 298.9 million, up from SEK 262.5 million in the prior-year period, while gross margin remained above 92%. The adjusted operating result nearly doubled to SEK 84.9 million, compared with SEK 39.7 million a year earlier. Reported operating profit also improved significantly, reaching SEK 72.2 million from SEK 29.6 million. The company said the adjusted operating margin for the quarter was 22%, reflecting the benefit of sustained growth, high gross margin, operating leverage, and continued financial discipline.

Net profit also moved sharply higher. Result for the period rose to SEK 53.4 million from SEK 10.4 million a year ago, and earnings per share before dilution increased to SEK 0.81 from SEK 0.16. Earnings per share after dilution came in at SEK 0.80, also up from SEK 0.16. External summaries of the report echoed the same improvement in bottom-line performance. Taken together, the figures show that BONESUPPORT is not only expanding revenue but also converting that growth into stronger earnings at a faster pace than before. That is often a key milestone for growth-stage healthcare businesses, especially those still investing in commercial expansion and regulatory development.

Cash Flow Strengthened Alongside Earnings

The first quarter also showed better cash generation. Operating cash flow reached SEK 74.9 million, compared with SEK 46.6 million in the same period of 2025. Management said the improvement was driven mainly by a stronger operating result. Cash at period end stood at SEK 455.3 million, up from SEK 267.1 million a year earlier, while net cash rose to SEK 441.2 million from SEK 254.5 million. Equity at the end of the period was SEK 938.9 million, compared with SEK 740.8 million a year ago.

These numbers matter because they give BONESUPPORT room to keep investing. The company is expanding commercially, funding clinical activities, preparing new regulatory filings, and building longer-term segment opportunities such as spine and revision arthroplasty. A strong cash position reduces financing pressure and gives management more flexibility to support growth initiatives without relying heavily on outside capital. In the CEO statement, Sköld linked the stronger cash flow directly to operating momentum, high gross margin, and execution discipline, arguing that these factors enable continued investments in commercial expansion while profitability keeps improving.

Clinical Evidence Continued to Build

BONESUPPORT’s first-quarter update was not only about financial performance. The company also highlighted two U.S.-based clinical developments that it believes strengthen the case for CERAMENT G. In February, the first U.S. clinical pilot study focused on trauma-related bone infection was published. BONESUPPORT said the study described surgical technique and treatment results with CERAMENT G and was conducted at a U.S. Level-1 trauma center before publication in OTA International. Management framed the study as strategically important because it provides real-world insight into how the product is being used in U.S. clinical practice.

Then, in March, the company pointed to the publication of the first U.S. clinical case series centered on infection prevention in trauma patients with open fractures. BONESUPPORT said the case series showed how local antibiotic release can be combined with existing surgical techniques, underlining CERAMENT G’s potential relevance in procedures where infection risk is especially high. Management acknowledged that the studies were limited in scope, but still described them as strategically meaningful because they help surgeons understand application techniques and expected outcomes as they consider integrating the product into daily use. For a company operating in a specialist surgical field, this kind of evidence can be crucial: surgeons often want proof not just that a product works, but how it fits into real procedures.

AAOS Feedback Reinforced Market Interest

BONESUPPORT also said discussions at the American Academy of Orthopaedic Surgeons, or AAOS, congress in March reinforced the commercial momentum it is seeing in the U.S. Management reported that presentations and discussions at the event confirmed strong clinical interest in the CERAMENT platform. According to the CEO statement, dialogue with surgeons and distributors suggested that CERAMENT G is being viewed as both clinically relevant and practically useful, including in more complex and acute situations where the need for bone healing and infection control is especially high.

While conference commentary is not the same as formal sales data, it often offers a useful read on adoption trends in specialized healthcare markets. When surgeon sentiment improves at major orthopedic meetings, that can lead to more product evaluations, training activity, peer discussion, and eventually broader hospital use. BONESUPPORT’s description of the AAOS response therefore fits with the wider message in the quarter: clinical traction and commercial traction are reinforcing each other. That combination may help explain why the company continues to emphasize disciplined market penetration rather than simply chasing volume.

Revision Arthroplasty and Spine Remain Important Future Areas

Beyond its established applications, BONESUPPORT said interest in revision arthroplasty continues to rise. Management said dialogue with surgeons in both the U.S. and Europe has deepened and that educational efforts are strengthening the company’s conviction in the segment’s long-term importance. Although the contribution to current sales is still at an early stage, BONESUPPORT said it is systematically building knowledge, evidence, and relationships. This signals that the company sees revision arthroplasty as more than a side opportunity; it appears to be one of the areas where CERAMENT could create additional growth over time.

The spine business is also advancing, though still selectively. BONESUPPORT said its focused launch of CERAMENT BVF to selected customers and indications is proceeding according to plan. Management described the current phase as important for expanding market understanding and identifying where CERAMENT G can create the greatest clinical value in spine surgery over the long term. In parallel, the company is preparing the regulatory pathway for an antibiotic-eluting version of CERAMENT for spine procedures, including the required clinical studies. These comments suggest BONESUPPORT is trying to expand its addressable market in a measured way, using data and targeted commercial execution rather than broad untimed launches.

Regulatory Work on CERAMENT V Remains a Key Watch Point

Another important part of the first-quarter update was the status of CERAMENT V in the United States. BONESUPPORT said the regulatory process is continuing according to plan under the FDA’s De Novo pathway and remains under active, constructive dialogue with the agency. The company noted that, as with the review of CERAMENT G, both the FDA’s Center for Drug Evaluation and Research and Center for Devices and Radiological Health are involved, and the lead review team remains the same as during the earlier 510(k) process. Management said BONESUPPORT has received questions within the De Novo process and is working to address the requested details and clarifications, with responses due by the end of August at the latest.

That timeline makes CERAMENT V one of the major strategic items investors are likely to watch through the rest of 2026. A successful U.S. regulatory outcome could open a new revenue stream and broaden BONESUPPORT’s platform in infection-related bone surgery. At the same time, the company’s language shows that the process is still active and not yet finalized. BONESUPPORT did not announce approval in the quarter, but it did present the regulatory dialogue as constructive and progressing as planned. That is encouraging, though still subject to the timing and outcome of the FDA review.

CMS Reimbursement Proposal Could Become a Major Catalyst

After the quarter ended, BONESUPPORT received what may turn out to be one of the most meaningful external developments in the report. The company said the U.S. Centers for Medicare & Medicaid Services, or CMS, proposed improved reimbursement for the use of CERAMENT G in complex orthopedic infection surgery. CMS also proposed more specific identification codes for CERAMENT G and CERAMENT V starting in 2027. According to the company, a final decision is expected in late summer 2026. BONESUPPORT said it views the proposals positively because they could better align hospital economics with the growing clinical value of CERAMENT G in key focus areas such as diabetic foot infections and revision arthroplasty.

This is a potentially important step because reimbursement can heavily influence how quickly hospitals adopt specialized products. Even when clinical evidence is positive, unclear or unattractive payment structures can slow uptake. If CMS finalizes improved payment terms, BONESUPPORT could benefit from a stronger economic case for hospitals and providers using CERAMENT G in complex procedures. In that sense, the proposed changes may do more than improve coding clarity; they could also support wider procedural use over time. That is one reason the company gave the topic prominent space in both its quarter summary and the CEO statement.

Possible NTAP Support Adds Another Layer to the Story

BONESUPPORT also disclosed that CMS has proposed New Technology Add-on Payment, or NTAP, reimbursement for CERAMENT V beginning October 1, 2026, provided the FDA grants the company’s De Novo application by April 30, 2026. If FDA clearance comes later, BONESUPPORT said it plans to submit a new NTAP application that could allow compensation support from October 1, 2027. This conditional framework ties reimbursement and regulatory timing closely together, making the CERAMENT V approval path even more central to the company’s outlook.

Even though the proposal is not yet final and depends on regulatory timing, it still strengthens the strategic backdrop for BONESUPPORT. NTAP can be valuable because it gives hospitals supplemental payment when adopting qualifying new technologies. For a company trying to accelerate use of a differentiated product in a complex hospital setting, that kind of support can help reduce financial hesitation in the early phase of adoption. BONESUPPORT was careful not to overstate the point, but by highlighting the proposal in its post-period events, management signaled that it sees reimbursement progress as a meaningful lever for future growth.

Full-Year Guidance Stays Intact

Despite foreign-exchange headwinds on reported figures, BONESUPPORT kept its full-year 2026 guidance unchanged. The company said it still expects sales growth exceeding 35% in constant currency for the year. That is notable because first-quarter reported growth was 14%, meaning management is clearly focusing on the underlying sales trend rather than headline currency translation. The CEO said the strong start to the year, expanding clinical evidence, and increasing impact in priority segments support confidence in the rest of 2026. BONESUPPORT also reiterated plans to hold a Capital Markets Day in Stockholm on May 26, 2026, to expand discussion around its market segments and strategic direction.

Keeping guidance unchanged sends a message that management believes the company’s current trajectory is sustainable. It also suggests that the quarter was not driven by a one-time boost. Instead, BONESUPPORT appears to be seeing a combination of durable demand, improving surgical familiarity, broader evidence support, and possible reimbursement tailwinds. That does not remove execution risk, especially in regulatory matters and international expansion, but it does frame the first quarter as part of a continuing trend rather than an isolated result.

What the Quarter Says About BONESUPPORT’s Position

Stepping back, BONESUPPORT’s first-quarter report paints the picture of a company moving into a more mature phase of growth. It is still expanding rapidly, yet it is also showing characteristics of increasing business resilience: very high gross margins, rising operating leverage, stronger cash flow, broader clinical validation, and clearer reimbursement momentum. Management argued that its market penetration is still relatively low but increasing quickly, leaving substantial room for expansion over many years. Whether that optimistic view fully plays out will depend on execution, surgeon adoption, and regulatory outcomes, but the first-quarter numbers give the company a credible basis for confidence.

For investors and market watchers, the most important takeaways from the quarter are likely these: the U.S. business remains strong, profitability is rising faster than many growth stories manage, clinical support for CERAMENT G is improving, and reimbursement developments could create a more favorable environment ahead. At the same time, BONESUPPORT still faces watch points, including the timing of CERAMENT V’s U.S. regulatory process and external uncertainty in some international markets. Even with those caveats, the quarter delivered a clear message: BONESUPPORT has entered 2026 with momentum, and management believes the foundation for further growth remains firmly in place.

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