When we released our analysis on February 10, Bonesupport was in the 8th percentile of its historical forward P/E, despite five straight quarters of positive cash flow and gross margins at the 100th percentile. Since then, the stock has traded above our base case median of SEK 199.85, reaching a high of about SEK 254 before falling back to SEK 226.40 after the Q1 2026 earnings report on April 22. The approximately -11% decline after the earnings places the stock between our base case and the P75 of SEK 275.83, and it remains significantly above the P25 threshold of SEK 141.69.
Q1 confirms our thesis rather than challenges it. Net sales of SEK 324 million show a 31% growth at constant exchange rates, with the U.S. business growing 35% CER (Constant Exchange Rate) to SEK 267 million, driven by widespread CERAMENT G use across foot and ankle, trauma, and arthroplasty. The adjusted operating margin of 26% stays within the higher range we noted in February, and the operating cash flow of SEK 75 million increased the cash reserves to SEK 455 million.
Gross margin slightly declined to 94.5% as the new 15% U.S. tariff began to take effect, with management forecasting a gradual ~0.8 percentage-point headwind through 2026—significant but manageable. The rise in selling expenses linked to the EUROW Booster program (~SEK 10 million, 18-month payback) partly explains the market reaction after the print, along with market expectations that had already outpaced the actual results.
The two binary items we identified as upside catalysts have developed unevenly. On the positive side, the CMS (Centers for Medicare & Medicaid Services) proposed rule for FY2027 IPPS (Inpatient Prospective Payment System), published in April, significantly reduces reimbursement risks: it includes better payments for CERAMENT G in complex infections, dedicated procedure codes for both G and V in line with the company's submission, and a proposed NTAP (New Technology Add-on Payment) for CERAMENT V starting October 1, 2026, contingent on FDA approval by April 30, 2026. The final CMS decision is anticipated in late summer 2026.
On the downside, the regulatory route for CERAMENT V has changed from 510(k) to De Novo, with FDA questions due by the end of August 2026. Management views this more as a timing issue than an approval one, but the April 30 CMS deadline will almost certainly be missed, potentially delaying the NTAP window for V until October 1, 2027, with a new application. This De Novo pathway is similar to CERAMENT G's 2022 process, which offers some reassurance, although it also lengthens the period during which competitors like J&J or Stryker might respond.
The stock now sits between our initial base case (SEK 199.85) and P75 (SEK 275.83), indicating that about half of our simulated scenarios are still above current levels over the remaining timeframe. Meanwhile, the P25 lower bound at SEK 141.69 has not been tested. The key catalysts (FDA De Novo response and CMS final ruling) remain unresolved within our forecast window and continue to shape the probability of extreme positive outcomes.
The board has suggested a share buyback program to use excess cash, with no dividend planned. The next strategic milestone remains the Capital Markets Day in the spring. Our view stays unchanged: operational success affirms the shift toward profitability; the reimbursement landscape is improving; and the regulatory delay on V is a postponement of opportunity, not a core franchise impairment. We are closely watching the August FDA response and the late-summer CMS final ruling.
The full analysis is available https://newsletter.kobenresearch.com/p/bonesupport
DISCLAIMER
Author: David López, Koben Research. First published: April 29, 2026
This publication is intended for educational and informational purposes and does not constitute investment, financial or trading advice, nor an offer, solicitation or personalised recommendation to buy, sell or hold any financial instrument.
The author is not a licensed financial advisor, broker or dealer, and Koben Research is not authorised or regulated by the CNMV or any other financial supervisory authority. As of the date of publication, the author holds no position in the issuer covered, has no intention to take any position within the following 30 days, and has received no compensation from the issuer. Quantitative projections derive from a GARCH + Historical Flexible Probabilities + Monte Carlo framework with t-Student; they are model outputs, not price targets.
All investment involves risk, including the potential loss of principal. Past performance is not indicative of future results. Readers should conduct their own research before making any investment decision.