Breaking Down Bonesupport Holding AB (publ) Financial Health: Key Insights for Investors

From its founding in 1999 in Sweden to pioneering the injectable bio-ceramic graft CERAMENT, BONESUPPORT Holding AB has built a focused orthobiologics story that reads like a case study in niche medical innovation and market execution: introducing antibiotic-eluting variants CERAMENT G and V by 2010, securing CE marking for CERAMENT BVF in 2015, listing on Nasdaq Stockholm in 2020, and leveraging a patented platform and clinical programs to address trauma, revision arthroplasty and chronic osteomyelitis-driving net sales to SEK 899 million in 2024 and then reporting a further SEK 568 million in 2025, a 40% year-over-year increase fueled by strong North American traction; with a capital structure of 66,764,350 shares outstanding (65,859,195 ordinary and 905,155 series C) and major backers such as HealthCap VI L.P. and Första AP-fonden, the company emphasizes scientific rigor, patient-centric antibiotic delivery, and reinvestment over dividends as it expands clinical evidence and commercial reach.

Bonesupport Holding AB (0RQO.L): Intro

• 1999 - Company founded to develop injectable, synthetic bone graft substitutes.
• 2005 - Launched the first injectable bio‑ceramic bone graft substitute, CERAMENT.
• 2010 - Expanded CERAMENT portfolio with CERAMENT G and CERAMENT V, both antibiotic‑eluting formulations to address infection control in bone healing.
• 2015 - Achieved CE marking for CERAMENT BVF, enabling broader commercialization across Europe and other CE‑accepting markets.
• 2020 - Listed shares on Nasdaq Stockholm, increasing public visibility and access to capital markets.
• 2025 - Reported net sales of SEK 568 million, a 40% year‑over‑year increase, driven largely by strong performance in the North American market.

• Bonesupport is a publicly traded company on Nasdaq Stockholm (ticker 0RQO.L), with shares available to institutional and retail investors.
• Ownership typically comprises a mix of institutional investors, boards and management holdings, and public/free float shareholders following the 2020 listing.
• Corporate governance follows Swedish corporate law and Nasdaq Stockholm regulations, with a board of directors, executive management and audit/remuneration committees.

• Mission: Develop and commercialize advanced orthobiologic products that improve bone healing and reduce infection and morbidity associated with complex bone injuries.
• Strategic priorities: expand CERAMENT adoption in key markets (notably North America and Europe), broaden clinical evidence, and enhance sales and distribution capabilities.
• Values and vision are aligned to clinical innovation, patient outcomes and scalable commercial growth - further detailed in the company's public statements: Mission Statement, Vision, & Core Values (2026) of Bonesupport Holding AB (publ).

• Act as a bone void filler that sets in situ and provides a scaffold for bone regeneration.
• Deliver local antibiotics when formulated as CERAMENT G (gentamicin) or CERAMENT V (vancomycin), achieving high local drug concentrations while minimizing systemic exposure.
• Be resorbed and replaced by native bone over time, supporting structural healing without the need for autograft harvesting.

• Product sales: Primary revenue derives from sales of CERAMENT formulations (BVF, G, V and related consumables) to hospitals, orthopedic and trauma centers, and distributors.
• Geographic expansion: Revenue growth is driven by market penetration, with North America highlighted as a major growth market contributing materially to the 2025 SEK 568M net sales figure.
• Distribution: A mix of direct sales teams in core markets, local distributors/partners in other regions, and hospital tenders/IDN agreements.
• Clinical evidence and adoption: Investment in clinical studies, surgeon training and key opinion leader engagement to drive uptake and justify premium pricing versus legacy graft options.
• After‑sales and services: Training, procedural support and potential device adjuncts that reinforce product use and recurrent purchasing by hospitals.

Bonesupport Holding AB (0RQO.L): History

• Founded to develop injectable, resorbable bone graft substitutes (CERAMENT).
• Transitioned from clinical development to commercial roll-out and international distribution.
• Emphasis on clinical evidence, partnerships and market access to drive adoption.

• Largest investors include HealthCap VI L.P. (life sciences VC) and Första AP-fonden (Swedish national pension fund).
• Ordinary shares carry full voting power; series C shares carry one-tenth vote and are held by the company, reducing representable votes at the AGM.
• Structure supports long-term strategic decision-making and alignment with growth/reinvestment priorities.

• Develop and commercialize synthetic, resorbable solutions that improve outcomes in bone void management and infection control.
• Create durable clinical and health-economic value for surgeons, hospitals and patients through minimally invasive solutions that reduce reoperation and infection rates.

• Product portfolio: CERAMENT® G (antibiotic-eluting) and CERAMENT® BONE VOID FILLER products sold to hospitals, orthopaedic clinics and distributors.
• Revenue streams: direct product sales, distributor sales, service and training programs, occasional milestone/license income from collaborations.
• Go-to-market: hospital tenders, key opinion leader-driven adoption, reimbursement and health-economic data to support uptake.
• Cost structure & investment: manufacturing, regulatory/clinical R&D, sales & marketing expansion; company prioritized reinvestment over dividend distribution (no dividend for FY2024).

Bonesupport Holding AB (0RQO.L): Ownership Structure

• Mission: Improve patient outcomes and healthcare resource utilization by providing effective, resorbable bone graft substitutes that support bone healing and reduce infection-related complications.
• Scientific excellence: Ongoing randomized and registry clinical studies to demonstrate clinical and health-economic benefits (multiple peer-reviewed publications and prospective trials in progress as of 2024).
• Patient-centricity: Focus on therapies that enhance bone healing, reduce reoperation and infection rates, and shorten hospital stays.
• Integrity and transparency: Regulatory compliance across CE mark and other jurisdictions, ethical clinical trial conduct and transparent reporting.
• Collaboration and continuous improvement: Partnerships with orthopedic surgeons, hospitals and payers to drive adoption and evidence generation.

• Product platform: Injectable, resorbable calcium sulfate/hydroxyapatite-based bone graft substitutes (CERAMENT) that remodel to native bone and may be loaded with antibiotics for local drug delivery.
• Clinical pathway: Used in trauma, trauma-related bone voids, chronic osteomyelitis and elective orthopedic procedures to fill voids, deliver local antibiotics and support bone regeneration.
• Revenue drivers: Product sales to hospitals and distributors, direct sales in key markets, incremental increases from new indications, and adoption in clinical pathways that reduce length of stay and reoperation rates.

• Ownership: Combination of institutional investors, mutual/asset managers and retail shareholders; largest holders typically include Nordic asset managers and specialist healthcare funds (ownership concentration can vary after public filings).
• Board and governance: Independent board with clinical and commercial expertise to guide product approval, market access and health-economic evidence generation.
• Capital strategy: Fundraising via equity and convertible instruments historically used to finance international commercialization and late-stage clinical work.

Bonesupport Holding AB (0RQO.L): Mission and Values

• Biphasic composition: CERAMENT is a biphasic injectable ceramic (calcium sulfate + hydroxyapatite) that remodels to host bone over months, providing both initial structural fill and long-term scaffold for new bone formation.
• Controlled resorption and remodeling: The calcium sulfate component resorbs faster (weeks to a few months) to allow vascularization while the hydroxyapatite persists longer to support progressive bone remodeling (typically remodeling documented over 6-12 months depending on defect size and patient factors).
• Local antibiotic elution: CERAMENT G (gentamicin) and CERAMENT V (vancomycin) are designed to elute high local antibiotic concentrations during the critical first ~30 days of bone healing, achieving bactericidal local levels while minimizing systemic exposure.
• Adjunctive bead and tray options: The CERAMENT Bead Tray permits formation of beads from the same injectable material for targeted delivery into complex cavities or for dead-space management where a bead form is preferred by surgeons.
• Wide orthopedic applicability: Products are used across trauma, revision arthroplasty, chronic osteomyelitis, foot & ankle and other osseous procedures where infection control and bone regeneration are required.

• Clinical studies: Bonesupport has sponsored multiple prospective and retrospective clinical studies and registry analyses showing infection resolution rates, bone healing and reduced reoperation in populations with chronic osteomyelitis and infected nonunions. These studies range from single-center case series to multi-center cohorts involving dozens to several hundred patients, depending on the indication and study design.
• Health economic impact: Published health economic analyses and hospital-level case series report potential reductions in length of stay, reduced need for systemic prolonged antibiotic therapy or multiple staged procedures, and lower overall cost-of-care in selected case cohorts when local antibiotic-loaded bone substitutes are used as part of surgical management.
• Regulatory approvals: CERAMENT products have gained approvals or clearances in major markets (including CE marking in Europe and regulatory clearances in other jurisdictions) for indicated orthopaedic uses; specific labeling and indications may vary by territory.

• Product sales: Primary revenue comes from the sale of CERAMENT product lines to hospitals and surgical centers via direct sales teams and distribution partners across Europe, North America and other markets.
• Channel mix: The company employs a mix of direct sales in key markets and distributors/partners in other territories to scale market access and adoption.
• Clinical adoption drivers: Reimbursement dynamics, surgeon training, and favorable clinical and economic evidence drive hospital procurement decisions. Adoption is higher where evidence shows reduced reoperations, shorter hospital stays or better infection control outcomes.
• Adjacencies and service: Revenue is supplemented by training programs, procedure support, and sales of ancillary devices (e.g., bead trays) that complement the core injectable offerings.

• Ongoing clinical evidence generation: The company continues to run prospective studies, registries and health economic analyses to expand label claims, demonstrate long-term remodeling and infection-control benefits, and support broader reimbursement discussions.
• Product development: R&D focuses on refining drug-elution profiles, procedural handling (e.g., bead systems) and expanding indications where local antibiotic delivery plus bone regeneration addresses unmet clinical needs.

Bonesupport Holding AB (0RQO.L): How It Works

• Core products: CERAMENT G (gentamicin-loaded) and CERAMENT V (vancomycin-loaded), plus the antibiotic-free CERAMENT Bone Void Filler used as a bone graft substitute.
• Primary clinical uses: trauma, revision arthroplasty, chronic osteomyelitis, foot & ankle surgery, and other orthopaedic indications requiring bone void filling and local infection control.
• Technology features: bioresorbable ceramic carrier, osteoconductivity, radiopacity, and controlled local antibiotic release to achieve high local concentrations with low systemic exposure.

• Direct product sales: Revenue is primarily generated from the sale of CERAMENT products to hospitals, orthopaedic surgeons and distributors.
• Geographic expansion: Growth has been driven by expanded market presence in North America alongside established sales in Europe and other markets, contributing materially to recent sales increases.
• Clinical and economic evidence: Ongoing clinical studies and health economic analyses aim to support reimbursement, adoption and price realization in hospital markets.
• Sales channels: Company direct sales teams in key markets, distribution partnerships in selected territories, and hospital purchasing agreements.

• Adoption in revision arthroplasty and trauma suites where bone void filling and infection prevention are high-priority needs.
• Health economic evidence to support cost-of-care improvements and hospital formulary uptake.
• Regulatory approvals and expanded labeling in additional indications and geographies.
• Local sales expansion in North America and further roll-out via distribution channels internationally.

Bonesupport Holding AB (0RQO.L): How It Makes Money

• Core product lines: bone graft substitutes and antibiotic delivery systems for trauma, revision arthroplasty, chronic osteomyelitis and foot & ankle surgery.
• Sales channels: direct hospital contracts, national distributors, and specialist orthopedic networks.
• Value drivers: patented technology platform, clinical trial data, reimbursement acceptance and surgeon adoption.

• Market position: Strong niche player in orthobiologics with a diverse product portfolio and patented delivery technology enabling differentiation versus standard grafts and systemic antibiotics.
• Financial posture: Reported net sales figures (SEK 899m in 2024 and SEK 568m in 2025) reflect rapid change and continued commercial expansion across indications and geographies.
• Clinical & pipeline activity: Multiple ongoing clinical studies designed to demonstrate clinical outcomes and health-economic benefits to support guideline inclusion and reimbursement.