Earnings call transcript: Bonesupport Holding AB reports strong Q2 2025 growth

Bonesupport Holding AB, a leader in the orthopedic bone graft market, reported robust financial performance for Q2 2025, with significant sales growth and a stable gross margin. According to InvestingPro data, the company maintains impressive gross profit margins of 92.6% and has achieved a remarkable revenue growth of 52.17% over the last twelve months. Despite a slight dip in stock price, the company’s strategic initiatives and product innovations are expected to drive future growth.

Key Takeaways

• Q2 2025 net sales reached SEK 284.4 million, marking a 29% increase.
• The company reported a stable gross margin of approximately 95%.
• Sales of Cerement G in the U.S. surged by 84%.
• Operating results stood at SEK 62 million, excluding incentive program effects.
• Stock price saw a minor decrease of 0.13% post-earnings announcement.

Company Performance

Bonesupport Holding AB demonstrated strong performance in Q2 2025, with net sales increasing by 29% to SEK 284.4 million. The company continues to outperform in the orthopedic bone graft market, driven by its innovative product line and strategic expansion efforts. The U.S. market, in particular, showed impressive growth with Cerement G sales increasing by 84%.

Financial Highlights

• Revenue: SEK 284.4 million, a 29% increase year-over-year.
• Operating results: SEK 62 million, excluding incentive program effects.
• Gross margin: Approximately 95%, consistent with previous quarters.
• Operating cash flow: SEK 50 million.

Market Reaction

Following the earnings announcement, Bonesupport’s stock experienced a slight decline of 0.13%, closing at SEK 296.6. According to InvestingPro analysis, the stock is currently trading near its Fair Value, with analysts setting price targets ranging from SEK 41.61 to SEK 49.31, suggesting potential upside. This movement is relatively minor and may not fully reflect the company’s strong quarterly performance and growth prospects. InvestingPro subscribers have access to 13 additional key insights about Bonesupport’s valuation and financial health.

Outlook & Guidance

The company reaffirmed its guidance for sales growth above 40% in constant exchange rates. InvestingPro data shows the company maintains a strong financial health score of 3.49 (rated as "GREAT"), with particularly high marks in growth and profitability metrics. Key initiatives include the anticipated launch of Cerement V in the first half of 2026 and potential price increases based on market acceptance. The company is also expanding its distributor network to cover new regions and enhance market penetration, supported by a healthy current ratio of 4.32 indicating strong liquidity.

Executive Commentary

CEO Emil Bilbeck stated, "We are winning almost every head-to-head comparison with any of the other products out there," underscoring the company’s competitive edge. He also highlighted the company’s focus on converting outdated practices into advanced, patient-centric care.

Risks and Challenges

• Regulatory hurdles: The company is awaiting FDA approval for Cerement V, with potential delays impacting timelines.
• Market dynamics: Temporary disruptions in the German market due to cost reduction programs could affect sales.
• Pricing pressures: Potential changes in reimbursement policies in the U.S. could influence pricing strategies.

Q&A

During the earnings call, analysts inquired about the expansion of the distributor network and the impact of preclinical spine studies. The company emphasized its strategic focus on expanding its reach and highlighted promising results from spine studies, which may drive future growth.

Full transcript - Bonesupport Holding AB (BONEX) Q2 2025:

Conference Operator: Now Now I will hand the conference over to CEO, Emil Bilbeck and CFO, Hakan Johansson. Please go ahead.

Emil Bilbeck, CEO, Bone Support: Thank you, operator. Good morning, and welcome, everyone, to Bone Support’s Quarter two twenty twenty five results call. I am Emil Bilbeck, the CEO, and I’m making this broadcast as always together with Hakan Johansen, our CFO. So over the next twenty five minutes, we will guide you through the presentation of the second quarter results, and then we will open up the line for question and answers. So if we go to the next slide, we will see the normal and usual disclaimers and just like to draw your attention to those in case are any forward looking statements we might make today.

We’ll go to next slide, slide three, and we start the presentation. So quarter two twenty twenty five was another strong quarter for Bone Support with solid execution across the business. Net sales came in at $284,000,000 Swedish krona, which corresponds to a growth of 29% versus quarter two last year. This is 40% growth in constant exchange rate. The difference between reported and actual in market growth is quite large, and that is reflective of the more than 10% drop in value of the US dollar to Swedish krona between the end of quarter two last year to the end of quarter two this year.

Comparing sales growth rates quarter two with previous quarters, we also need to remember that Easter, which usually eliminates two to three surgery days in a quarter, was in quarter one last year and happened in quarter two this year. This usually impacts between three to four percentage point. Despite this, quarter two in 2025 grew sequentially with 9% over quarter one twenty twenty five in constant currency. So for the first half of twenty twenty five, sales amounted to SEK $568,000,000 and a growth rate of 44% in constant currency. Our operating results excluding incentive program effects was SEK 62,000,000, reported EBIT at SEK 55,000,000 and with an operating cash flow in the quarter of SEK 50,000,000.

Looking at the highlights from the quarter, I would like to mention the strong Cerement G sales in The U. S, which reached sorry, which reached $18,300,000 in the quarter. This is a growth of 84% in market, meaning in constant currency, and 66% when converting that and reporting in Swedish krona. We announced the appointment of Torbjorn Gald as the next COO of Bone Support. He will assume his role on September 1 as I will transition to a role as senior adviser.

Furthermore, the proposed NTAP for Saramant G in open trauma as well as general orthopedic increase of DRG codes by CMS, which we mentioned already in the previous quarterly call, bode well for the future. The quarter also saw additional clinical studies validating the strong value proposition of Saramund. We will also cover all these topics later in the presentation as well as the impact from the hospital reform at several German hospitals. Let’s now go into the core of the presentation and go to the next slide. So this chart, as many of you will recognize, shows the sales in the last twelve months in Swedish currency every quarter for the last seven years in, we display this in stacked bars per region and product category.

So as you can see, the launch momentum for G in The US is exceptionally strong. We’re pleased to announce that since the launch in quarter four twenty twenty two, the accumulated sales for Serument G in The US has now reached SEK1 billion. Visually, it almost looks as if the last quarter is slowing down, which is of course not the case. It is an effect of the sharp drop in dollar to SEK. And if we look at the growth at constant rates for the last twelve months, the LTM in quarter two versus quarter two a year ago, the growth number is 47%.

In total, antibiotic eluting cerumen grew with 49% in the last twelve months for the quarter for the global business. Let’s push forward and go to the next slide, please. In North America, quarter two sales reached million, which is a growth of 36% compared to quarter two last year or 49% at constant exchange rates. As mentioned, we’ve seen large swings in the U. S.

Dollar to Swedish krona rate, which is impacting both reported sales and sales growth. The uncertainty regarding the future of potential tariffs continue. Regardless of outcome in this volatile situation, the impact on Bone Support will be very small as we have covered previously in the April press release. Some highlights in the quarter. We’re seeing strong progress in the market penetration for Saramet G with sales reaching US18.3 million dollars The growth is coming from new users, but even more so from increased and expanded use in broader sets of indications by surgeons that have made their first experience with Ceremon G six to twelve months ago.

We are making steady progress in getting Ceremon G approved with hospital systems, and we are quickly approaching 200 systems listing. It takes anywhere between three to nine months to get an approval for a listing with a hospital system. And usually, the bigger the system, the longer time it takes. We will continuously see a lot of go stop go dynamics. But so far, there’s only one or two of the hospital systems that have rejected to list Saramant G.

The knowledge of the benefits of bone repair with local illusion of antibiotics is increasing. To further nurture the growth driven by increased demand, we have signed up a few specific independent distributors specialized in trauma and specialized in prosthetic joint infection. We’ve done this for states and regions where we did not have coverage with our legacy distributors. The submission to FDA for market authorization of settlement V was made at the March. During quarter two, we received questions and requests for clarification on the data from FDA.

The submission follows a five ten ks pathway where sediment g has been used as a predicate device. The package of questions received should be looked at in the perspective of the very rigid and very demanding requirements on clinical data, illusion profiles, and special controls established when the category of antibiotic eluting bone grafts was established by FDA. There is, by the way, only one product in that whole category, and that is the Cerement G. But by the end of this year, we hope to be able to add one more product to that category, namely Cerement V. The deadline to respond to FDA’s question is in November.

The expectation is that Serument V will open up additional avenues for growth in The US market and increase the pace of market penetration for use of local antibiotics. The therapeutic ratio is totally different with local antibiotics versus systemic antibiotics, which has been shown in many clinical studies among those the Solario study. With both gentamicin and vancomycin in the toolbox, we believe that we completely meet all The US surgeons need for treatment and prevention in relation to bone healing. Go to next slide, please. So finally, when it comes to The U.

S, I would like to give an update on the plan for our spinal procedure market entry. At the Capital Markets Day end of twenty twenty three, we announced that we will eventually enter the area of spinal procedures with both Sarament BVF and Sarament G in The U. S. Since then, supplementary regulatory approval has been accomplished for Serument PVF and several preclinical application studies have been conducted and even more are ongoing. The launch into the spine segment with Sarament BVF will take place in December of this year.

We are launching simultaneously in The U. S. And in Canada. The launch will start with orthopedic departments where Sarament is already fairly established and used for extremities. Sarament is overall starting to become quite well known in the market and there’s a large amount of high quality public data on the bone remodeling capabilities of Saramand, including a level one randomized clinical trial showing equivalence to autograft.

This is in extremities. So in spine, well, while there are some patient case series, there are no published clinical studies yet. This is something that we will address and generate over time with our partner hospitals. Recruitment of specialized independent distributors focused on spinal procedures is ongoing. Details on regulatory and clinical study strategy for Ceremet G in spine procedures will be presented in the autumn twenty twenty five as earlier announced.

The pictures on the slide just show a few snapshots of some of the details generated from the preclinical study data. These ones are from a fusion study using Saramant according to the Boden model. Strong fusion results were recorded across the study samples. Now let’s turn to Europe. Next slide, please.

Sales in euro came in at SEK 49,000,000, representing 4% year over year growth, which is 7% at constant exchange rate. Sales in Great Britain is in recovery from the NHS imposed surgery priority program. Every month has seen gradual increase in number of surgeries and growth rates versus previous year, leaving the quarter at a percentage growth in the mid teens. Sales growth in percent for the quarter was negatively impacted by fewer surgery days, a strong comparative quarter in 2024 and the ongoing hospital reform in Germany. A number of German federal states have launched cost reduction programs related to hospital consumables and surgical procedures.

The programs have resulted in quite a disruption for us with some hospitals reverting back to the use of autograft at the expense of synthetic bone grafts. What we have seen previously with similar historical cost driven initiatives is that the dip is rather temporary in nature as it relates to innovative products capable of improving the standard of care and providing strong health economic data. To drive understanding of the benefits of Saramant, we intend to further intensify our efforts with decision makers on all levels. Saramant has very strong evidence supporting confirming the benefits given to patients, caretakers and payers. In the quarters, two additional clinical studies were published in well reputed medical journals with impact factors of 1.8, respectively 2.8.

Reduced amputation rate has previously been shown in clinical studies both from The UK and from Australia. And the recent study was made at Herdev Hospital in Denmark shows similar strong patient outcome following a dedicated protocol where Cerament G or Cerament V was used. The second study mentioned here follows a patient group that has been featured in previous publications by Henry and Aljavadi. The recent publication shows that the great results on deep infection avoidance and avoidance of amputation withheld and remained also over long term period follow-up. The study had a ten year follow-up of patients that previously had been reported on in a four and a half year follow-up.

And with that, I will leave to Hakan to do and lead us a deep dive in the numbers. Thank you, Emil.

Hakan Johansson, CFO, Bone Support: So net sales improved from SEK 219,800,000.0 to SEK 284,400,000.0, equaling a reported sales growth of 29% or 40% in constant exchange rate. AML has already spoken about the strong performance in especially The US and the major drivers behind the sales acceleration. But as the weak US dollar somewhat hides the continued strong trajectory in The US, I would like to share The US sales performance in US Dollars. This slide shows the quarterly sales in The US in US dollars. Not only can we see a strong performance in this quarter, but also a strong performance over the years, with double sales in recent six quarters and tripled sales over the recent nine quarters.

The dollar growth in a quarter of 49% should be viewed in perspective of a strong record strong quarter Q2 last year. The contribution from the North America segment improved with SEK 37,600,000.0 and amounted to SEK 104,400,000.0. The improved contribution relates to increased sales of the defect from increased costs. Sales and marketing expenses during the quarter amounted to SEK 117,800,000.0 compared with SEK 98,300,000.0 previous year, of which sales commission to distributors and fees amounted to SEK 78,500,000.0 compared with SEK 61,600,000.0 the same quarter last year. From the lower graph showing net sales as bars and gross margin as the orange marker, it can be noted that the gross margin remains stable and strong around 95%.

In Europe and rest of the world, a contribution of SEK 13,600,000.0 was reported to be compared with SEK 14,200,000.0 previous year. Sales and marketing expenses increased with SEK 2,200,000.0 including SEK 2,100,000.0 related to the previously communicated commercial investments in the Euro booster program. From the lower graph and the orange marker, a minor drop in gross margin is noted mainly impacted by market mix. The decrease in selling expenses is due to a depreciated US dollar, but also an effect of seasonality depending on how the expense for large conferences play out. As mentioned previously, the quarter also included SEK 2,100,000.0 related to the Euro booster program.

R and D remained focused on the execution of strategic initiatives, such as the application studies in spine procedures and the market authorization submission for Cerment V in The US. These initiatives have been progressing well during the quarter and, among others, leading up to the launch of our product segment BVF in spine later this year. And administrative expenses, excluding the effects from the long term incentive programs, remain on a stable level involving a SEK 1,000,000 in non recurrent expenses in the quarter. The reported operating profit amounted to SEK 54,900,000.0 despite unfavorable currency effects totaling 11,400,000.0. I will come back to this in a following slide.

There is no impact from tariffs in the quarter, and we are following the conversations between EU and The US with great interest. It should be said that regardless of the final outcome, the impact on bond support is expected to be nonmaterial. As an example, a 10% tariff implemented in our business would have meant an EBIT reduction on the just reported quarter q two this year of 1,300,000.0 SEK or about 2% of reported adjusted EBIT. A worst case scenario with 30% tariff would have meant a reduction of the reported EBIT of 4,000,000. The difference between adjusted EBIT and reported EBIT are costs related to the long term incentive programs amounting to an expense of SEK 7,600,000.0 in the quarter compared with SEK 7,300,000.0 previous year as you could see on the previous slide.

Cash conversion remains solid with a fourth consecutive quarter with strong cash flow and an increase in cash during the period with 42,600,000.0. With this report, with a strong adjusted operating result despite unfavorable currency effects and a solid cash flow, we continue to confirm a strong operating leverage and business scalability. During the period, the Swedish krona has continued to strengthen against the US dollar. Other operating income and expenses therefore contain foreign exchange gains and losses from the translation of the group’s assets and liabilities in foreign currency amounting to a negative 11,400,000.0. Simply put, the negative 11,400,000.0 is mainly driven by the operating assets in The US such as inventories and trade receivables.

These are already valued in US dollars and at quarter end translated into a much stronger Swedish currency versus the last quarter. The graph on this slide shows with the gray bars how the relationship between the US dollar closing rate and the Swedish krona has varied over time. This is read up on the right eye axis. The blue dotted line read up to the left of the eye axis shows reported adjusted operating result. The adjusted operating result excluding translation of change effects is the orange line.

In Q4 twenty twenty four, the U. S. Dollar to SEK rate was SEK 11 0.03, which gave a positive effect of SEK 20,000,000, and therefore, the blue dotted line is above the orange line. In Q1 this year, the U. S.

Dollar rate was at 10.02, creating a negative impact of SEK 30,000,000. And in Q2, the U. S. Dropped down to SEK 9.49, creating a negative impact of SEK 11,000,000, meaning that the blue dotted line drops below the orange line for these two quarters. The orange line eliminates the translation exchange rates and give a more comparable view of the underlying trend in operating profit.

In the table below the graph, you can see the FX adjusted operating margin of 26% in the period compared with 16.8% in the same quarter last year and compared with 24.6% in Q1 this year. And with this, I hand back to Emil.

Emil Bilbeck, CEO, Bone Support: Thank you, Oka. So to summarize, we’ve seen a strong momentum in 2025 with 40% sales growth at constant exchange rate in the quarter and 44% in constant exchange rate for the first six months. The continued success for Cerment G in The US is one of the main drivers for this strong growth, and yet this product has just begun its journey towards its full potential. We have a strong underlying profit development and operational cash flow of SEK50 million in the quarter. So all in all, we are confident in our guidance of sales growth above 40% in constant exchange rate for the full year.

Bone Support continues to perform steadily, converting an outdated standard practice into technically advanced patient centric care. And we remain committed to expanding into new geographies and indications as we’re now starting the ramp up for the December spine launch. So let’s open the line for questions.

Conference Operator: The next question comes from Matthias Vatston from SEB. I

Matthias Vatston, Analyst, SEB: have a few Take them one by one, I think. First one, you said something regarding expansion of distributor network. I think it was trauma and prosthetic joint infection where the distributors the legacy distributors for you is not covering those. So my question is really how many states or regions does this cover?

And do you foresee an uplift of these sales already from quarter three? I’m just trying to get a feel for the incremental upside from this move. That’s the first one.

Emil Bilbeck, CEO, Bone Support: Yes. Thank you, Matijas. We have we have shown at a couple of places before how how early we are on the journey with CeremonG in The US and that our market shares is, less and in its infancy in both trauma and in, prosthetic joint infection. And and there are a couple of reasons for this. We we got the approval for trauma, only a year ago, and we launched in October.

On PJI, we have barely gotten started. We’re still waiting for the clinical study from a charity in Berlin to support our case and to give valuable data points to drive penetration. But we’re starting also already now to see more demand from the market. There are surgeons calling us that we have not been in contact with before within open trauma. There are surgeons calling us with infected joints, and they ask if they could start using the product.

So we have signed up specialist distributors to cover these target groups where our previous distributors couldn’t cover. Now the question you ask is, well, how to quantify this? What should we expect going forward? What you should expect going forward is many years of very strong growth. If we will succeed in trauma, if we will succeed in PJI as we have done in other areas, we will also have continuous and further opportunities to seize, then this company will be on a very long growth trajectory.

But exactly how that will translate into distributors, regions, states, I I think we we cannot share that data, from time to time. I think one important observation is surgeons are starting to call us. Distributors are coming to us. Saramant G has a very strong reputation in the marketplace And those surgeons that have used it also speak with their colleagues in other indications, which is creating a strong demand. But the specific numbers, unfortunately, we will not be able to share that.

Matthias Vatston, Analyst, SEB: I appreciate that. And I think that’s a good answer. Second one relates a little bit to Spine procedure. I think it’s two questions in one really. But on the BDF and the preclinical application studies, so can you say anything about what results you’re seeing?

Can you talk anything about fusion rates based on and what you’re seeing and what you expect maybe? And if the results are overall in line with your expectations beforehand or if they are even better? And then on ferment G, they’re in Spine Procedures. So what makes you confident in an updated time line, autumn twenty twenty five? Does this mean that the preparatory work is developing in line with expectations?

And if you can maybe start a study towards the end of this year? Or how should we look upon that? Thank you.

Emil Bilbeck, CEO, Bone Support: So we have done a lot of preclinical testing on Saramant BVF. We have also done some on Saramand G. Some results are ready since a while ago and other results are pending to be finished with the report and others are still to be completed later during this year. You asked specifically about fusion, but so let me say that we’re targeting spine procedures quite broadly where we’re looking at several different application areas and several several different indications. But when you when you ask about the fusion specifically, yes, we have done fusion studies with the Boden model, which you can say is a bit of standard at least when it comes to preferences expressed by by FDA.

This is a a demanding model. This is a rabbit spine model to intended to replicate human fusion. And, yes, the results are very good. Now we don’t release results from preclinical studies, we feel that could be quite deceiving. I think we should wait until there are clinical studies, which we intend to start up sometimes next year when we have established the partner centers.

But I wouldn’t sit here today and tell you that the launch takes place in December year unless we had very encouraging results from the preclinical studies. When it comes to Ceramand g, well, the contrast here is Ceramand BVF has gone to market or will go to market through a five ten k. So there are there are products in the market and a lot of them are performing within a certain range so they can get the regulatory approval. When it comes to Ceramen g or v for Spine, there is nothing like it. There’s not there’s nothing even close to it, which means we will have to again create a new category.

We feel confident in doing that. We have done that before, and we’re one of the few companies that have succeeded. We have the first ever combination product of medicinal substance and medical device registered through De Novo in orthopedics. And de novo is the pathway most likely that we would have to go through with Saramen G for spine. And there’s still some conversations that has to be had with our external partners, with FDA, with regulatory consultants before we feel that we can give a clear timeline.

But you can be very sure that since we addressed the market from the Capital Markets Day, we have been working very hard to get all the pieces of the puzzle in place. And it’s not long more that people have to wait now for us to be able to share when and how that will look like going forward.

Matthias Vatston, Analyst, SEB: Sorry for the long question. I think that’s a good answer. Thank you very much.

Emil Bilbeck, CEO, Bone Support: Yes. Thank you, Matthias. And sorry for the long answer. Do we have The next

Conference Operator: question comes from Christopher Lilleborg from DNB Carnegie. Please go ahead.

Christopher Lilleborg, Analyst, DNB Carnegie: Yes. Thank you. Two questions here. Three actually, but the first one are related. So on the selling expenses that were down here sequentially, how much of that is just a U.

S. Dollar effect, if that’s possible to quantify? And related to this, I’m wondering, have you viewed the potential operational leverage going forward, I. E, how much are you planning to increase operating costs here for the remainder of the year, maybe into 2026? And that’s, of course, excluding the royalty you paid to distributors or distributor commission?

So that’s my first question. And then how do you view the potential to accelerate this sequential growth you see in the U. S.

Matthias Vatston, Analyst, SEB: U. S. Dollar? Thank you.

Hakan Johansson, CFO, Bone Support: Well, thank you, Kristoffer. And again, Samaj, I can understand the questions more related to expenses also giving small. So that that as with revenue, there is naturally also consequences in in terms of translation of expenses in in foreign currencies. The FX impact in the the the quarter is around 5,000,000 SEK from from currency. And the rest is is coming back to as as we mentioned, somehow, it’s it’s it’s the seasonality.

It’s really also the timing when the the last congress is is is happening.

Emil Bilbeck, CEO, Bone Support: That was the first part. And then on the operating cost going forward?

Hakan Johansson, CFO, Bone Support: Again, we we have been been giving guidance on on on revenue and and revenue only, and that we have have communicated that we expect, about this year, to grow with with with more than than 40% in constant exchange rates. And the reason for not being more disclosed in terms of of expenses or operating result is that somehow we continue to to do investments. We continue to do commercial investments, and we communicated late last year some of the the Eurobooster program, etcetera. And we will seek all potent opportunities to continue investing in in in continued sales growth. For that for that reason, we don’t give any firm guidance on on operating expenses.

However, saying that, well, yes, by looking at the the general trajectory, we can see that whether we talk selling expenses and general and administration, etcetera, we can see that it’s coming down as a percentage to sale despite those initiatives and cost increases.

Christopher Lilleborg, Analyst, DNB Carnegie: But you’re not planning any larger programs rest of the world or adding a large number of sales reps in The U. S. Or any big clinical trials that will will significantly increase R and

Erik Cassel, Analyst, Danske Bank: D cost or anything like that?

Emil Bilbeck, CEO, Bone Support: No. That’s right. Not not that we’re not.

Hakan Johansson, CFO, Bone Support: I think it’s fair to say that we we have a tradition to to communicate such an initiatives in good time in advance.

Emil Bilbeck, CEO, Bone Support: Yep. I mean, there’s no hesitation to to invest, but it’s rather three, four people in in different slots of the commercial or or central organization that wouldn’t have that kind of pivotal effect. So you also have the question on how how confident are we on accelerating the sequential growth in in US dollars. And I assume you you refer to to Cerement GE. So such a breakthrough in Pioneer product is gonna be an intensive launch phase for the first sixty months.

It it takes it takes about five years to really be actively launching the product, and then you have to nurture the and continue to build the customers. What we see today is it’s it’s an everyday battle. Everyday battle to get the attention from the surgeons, everyday battle to to convince them to go through the science, go through the clinical studies, use the product, and then follow-up on the product. And, we’re not alone in the marketplace. We are one of the smallest players, but we’re one of the fastest growing.

There are some gigantic sales teams out there from big orthopedic companies, and it happens that just by force and total assortment, they convince customers to switch back to older kinds of orthobiologic products, even like bone cement, when it is given to them as part of a package deal when the customer buys robotics, hardware, metalware, knee implants, and and all other things. The the KPIs that we follow, with the exception of sales, of course, sales is one of our main KPIs, is how many doctors we convert, how many hospitals to put us on listing, and how many protocols we show up in. But over the over the first five years of launching a product, we will win accounts and we will lose accounts. But overall, it’s like stopping a tidal wave. We are winning almost every head to head comparison with any of the other products out there.

So by commercial muscles, sometimes we lose an account and sometimes we win an account. But in the long term, we are strongly convinced that Sarament will become a major part of standard of care. As we are opening up more indications, as we are increasing also loyalty with customers who have used Sarament, maybe being convinced by one of the big orthopedic companies to switch back to an older therapy and noticed they don’t get the same results. So they’re switching back to Saramund. As all these dynamics will stabilize, I am sure that we will see also an acceleration in our growth from Saramund G versus a rather linear trend that we have seen over some of the recent quarters.

Again, a long a long answer again. Sorry. But hopefully, it was clear.

Conference Operator: The next question comes from Sten Gustafsson from ABG Sundal Collier. Please go ahead.

Sten Gustafsson, Analyst, ABG Sundal Collier: Good morning. A few questions here. Firstly, on the hip and joint potential you talked about, just maybe a clarification. Is that part those patients are they part of the sort of the addressable market that you have talked about in the past of around fifty thousand infected and ninety thousand for prevention use? Or is this incremental new potential procedures that you will target going forward?

And if that’s the case, what does the time line look like? When will you start to address those potential procedures? Thank

Emil Bilbeck, CEO, Bone Support: you, Stan. The procedures related to infected prosthetic joints is part of our total addressable market as we have identified it. However, we have not done so much efforts in this area. So it’s a rather untapped area within the total addressable market. Why have we not?

Well, when launching a breakthrough product like Ceramen G, the surgeons will try the product in various different ways, And we are trying to take the lead to explain which protocols, which manuscripts we believe will work the best in different applications technique for the different surgical techniques there. There’s so many different surgical techniques that exist. Many of them have the last name of the person who invented them, and and we have to adapt many times how to use the product to fit different techniques. In in PJI or in in joint infections, there are several doctors that are now starting to use the product very intensely. And what we can tell, they have also very strong results.

But we don’t have any published clinical study with a clear instruction on how have the study authors used the product, which techniques have they used to arrive at the conclusions and the results they have. So when that comes, hopefully now after summer in a in a published way, we will have the chance to further explore this group and we expect strong market penetration. Then local antibiotics is used preventively for joint surgeries. This is a huge market, but we don’t have that on label yet. So we have actually excluded that from our total addressable market.

Of course, there might be surgeons that decide that they have such good results with Serumin G for their infected joints that they decide also to use it to prevent the infection from even establishing. But this is something that we have to pursue more long term to also broaden the label into prevention of joint infections, and then it will be a significant increase to the total addressable market. But this is something we will have to come back to because we don’t have clear plans to communicate on these steps yet.

Sten Gustafsson, Analyst, ABG Sundal Collier: Thank you very much for that clarification. My second question would be on I think you mentioned in the text, and correct me if I’m wrong here, but you talk about reimbursement positive reimbursement changes in The U. S. And whether or not you see a potential there for raising your prices. I think we talked about this the after Q1 as well, but maybe you know more today on that topic and also on the MTAP, if you could just remind me on the sort of the net effect of the MTAP for the two different parts?

Thank you.

Emil Bilbeck, CEO, Bone Support: Yes. Yeah. So so we’re we’re positive, to see that CMS has made a proposal, a proposal to basically themselves. They make the proposal, and they also make the final decision in August. They made a proposal in general to increase the the diagnostic related group codes, so the reimbursement codes for, orthopedic extremity surgeries with six percent effective 2026.

This is an increase which is close to twice as much as they’ve had previous years. So it it it shows that there’s a broader understanding and recognition taking place that orthopedic surgeries actually do have a very positive impact on total health economics because the patient comes back to mobility and to a normal life. So we are looking constantly at raising prices, and we we do that in different ways. Whenever the market allows and and would accept a raised price, we will take that opportunity. So not specifically related to higher reimbursements, but related to what we believe that the health care can carry in terms of cost related to the benefits that we provide.

The NTAP that has been proposed is on open trauma. So before we’ve had an NTAP which was on infection, meaning if there was an an infection present. And the NTAP that is now being proposed is for the use of Serumin G preventively. We we do believe that NTAPs on prevention is slightly more relevant than if you have an infection. Why?

Because if there is an infection, you’re probably had also quite a severe injury. The codes the DRG codes, the reimbursement codes will be high, as they are. While prevention, is the codes does not reflect that you have an infection because the infection hasn’t started yet. So an NTAP will, of course, function for some surgeons as a tipping point of making the choice to do effective infection prevention versus hoping for the best. The prevention NTAP in open trauma will be decided in August and be effective from October if the decision is positive.

Sten Gustafsson, Analyst, ABG Sundal Collier: Just a follow-up. On the NTAP for already infected patients, is in place today, do you see a chance that NTAP will remain, because I think that’s about to, disappear. Is that correct?

Emil Bilbeck, CEO, Bone Support: Yes. There there is a discussion with FDA. Sorry. There’s a discussion with CMS. I’m mixing them up.

There’s a discussion with CMS, of course, to I used the word to permanent the codes,

Matthias Vatston, Analyst, SEB: but what it what it

Emil Bilbeck, CEO, Bone Support: basically means that that those specific codes where NTAP has been used, because the DRG codes in themselves was rather low in the past, we are pledging and pushing for those to get a permanent increase. And CMS has been a bit overwhelmed with administrative work recently, so we have not received answers. And that’s fine because the final decision will be taken also in August, which is next month, which codes and if there will be a permanent increase to accommodate an innovative product like Cerement G. Historically, we have seen both rejections of, when the NTAP has disappeared, there has been rejections of raising the codes, and we have seen acceptance when it comes to other, innovative medical devices. So we couldn’t give any forecast or readout on the observations we have so far from the conversations, but have to wait probably another one and a half month before we will have a final decision from CMS.

Conference Operator: The next question comes from Erik Cassel from Danske Bank. Please go ahead.

Erik Cassel, Analyst, Danske Bank: Hello. Good morning, everyone. First question on Servant V. Now given that the FDA has returned with some questions on that, how do you see the likely timeline for getting that to market?

Emil Bilbeck, CEO, Bone Support: Oh, that’s a million dollar question or even more, I would say. It all depends on on FDA actually. They they have undergone quite some disruptions with the entry of the new US administration. Now Servant v is a breakthrough device, and I must say that the contacts we have had on FDA have worked diligently through the extensive material. So once we get the approval or final final notification from from FDA, we will need a couple of months for production.

So we are not producing these products in advance. The reason is that even though it’s a five ten k using Serumin g as a predicate device, it is a breakthrough therapy. It is one of its kind, and it will come with very strict quality controls, batch controls like we have today. I I think I’ve shared with with the market that every batch we produce on Saramen g, we have to do specific measures and control parameters related to, among other things, the illusion of antibiotics. And if we have similar demands for Saramet v, it will be difficult if those products are already, preproduced.

So let’s say, best of case, we answer the questions in November and there’s a fast process. I couldn’t speculate on that, but theoretically, then we would launch somewhere in the first six months of 2026.

Erik Cassel, Analyst, Danske Bank: Okay, good. Thank you. Then I wanted to understand the setup for sales and distribution a bit more on spine and sort of what commissions we are to expect and really just anything you can share on the likely setup you’re going to go with for selling in spine?

Emil Bilbeck, CEO, Bone Support: Absolutely. So very few of our existing distributors cover both extremity and spine. There are a few, and and we will work with them. But mainly, what we have is calls incoming calls from distributors completely specialized in spine and spine instrumentation. And they have heard about Serument.

They’ve seen Serument. They have surgeons that have requested it. In top of that, we are also reaching out through our networks to a few of these very specialized spine distributors. They are independent distributors, so we’re not signing up a partnership at this stage with any large sales team. It will be independent distributors that have between three sales reps, maybe up to thirty, forty sales reps.

And the commission will be on the same the the price of the product will be the same as an extremity, and the commission will be the same as we have an extremity. We have validated this, and we’ve already had discussions with distributors. And given that Cermant has such strong documentation in extremities and such strong and evolving and growing reputation, the commission will be the same between the two indications. So around 30%, plusminus 5%.

Erik Cassel, Analyst, Danske Bank: Perfect. And then just the last question, a housekeeping one, we can call it. There seems to be a lot of confusion on the FX effects now as well, seeing FX negative eighteen percent on servantry in The U. S. Where isn’t really how the U.

S. G. SEC has developed year over year, but I understand there’s some special effects there. Can you just get it can you sort of explain it so we have it on the books how that sort of FX effects work?

Hakan Johansson, CFO, Bone Support: So, again, somehow, doing this very technical, Eric, is that somehow the all the financials, somehow, we take the the the translation of revenue and cost is down by using the the yearly average FX rates. And then the reported quarter is the the year to date less previous reported quarter. And that somehow gives us an impact somehow more or less or equal to the average FX rate in the the reported quarter. So it becomes a bit technical. And somehow, you you have to work the numbers when you compare the the the various years to to, somehow, understand the the movements in between.

And that’s why also, again, somehow, we we took the opportunity today to show the the revenue graph in US dollars as well when it comes to the to The US.

Erik Cassel, Analyst, Danske Bank: Alright. Great. Yeah. I appreciate the the USD graph that you showed. I’ll jump back in the queue.

Thank you.

Emil Bilbeck, CEO, Bone Support: Yes. Thank you, Eric. So the it is indeed a bit confusing also because the dollar is swinging pretty rapidly. But you can rest assured that the numbers we share with you are all audited. Okay.

So we I think possibly we have room for one more question before we break this up. Are there any more questions online?

Conference Operator: The next question comes from Maria Vara from Stifel. Please go ahead.

Maria Vara, Analyst, Stifel: Hi, good morning. Thank you for taking my question. Maybe a very last one question could be, what is the pricing that we expect, for Ceramen BVF when we launch it in spine in The U. S? Could we think about a similar range to what you’re charging for extremities and if this is under any kind of reimbursement code?

Emil Bilbeck, CEO, Bone Support: Yes. Thank you, Maria. What a lovely way to to to finish this session. So the price the the the weighted price for Saramant BVF is around 604,650 US dollars. And and that is a blend of the three different sizes that exist.

It’s the five milliliter, it’s the ten milliliter, and it’s the eighteen milliliter. Before we announced that we would go to this into spine procedures, we did extensive market research, and we have continued with that market research after the announcement that we did at the end of twenty twenty three, where we have had big focus groups and also advisory boards, and we’ve done general surveys and market research to see what is a price that would be accepted for this kind of product. And it has landed that the price between spine and as we charge an extremity would be the same, namely a weighted average around 2,600, 2,650. When you look at the reimbursement codes, they’re quite generous in spine, but it also depends on the severity of the injury. So or or the intervention.

So let’s say there’s a spinal fusion, an interbody fusion, or it’s a posterolateral fusion, they both come with codes that have no problems to accommodate sediment BVF. If we look at scoliosis, for example, big codes, big reimbursements. So we don’t expect any pushback. We’ve also done price. We have also compared our intended pricing point with what is common in the market, and we have got also that confirmed that we are on the right level.

And then Sariment G in the future, well, something we will have to come back to when when all that material is in place.

Maria Vara, Analyst, Stifel: Thank you. Very clear.

Emil Bilbeck, CEO, Bone Support: Thank you, Maria. And with that, I think we we wrap up this session. And thank everyone for taking the time to to call in and listen to our presentation on on quarter two. And, also would like to wish everyone a nice summer, and thank you for the great work that we’ve had together during my seven and a half year as CEO for Bone Support. Thank you and goodbye.

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