Orthofix Medical (OFIX) Q4 2025 earnings summary

Executive summary

• Achieved strong operational progress in 2025, with consistent performance in Bone Growth Therapies (BGT), U.S. Limb Reconstruction, and double-digit global spine fixation net sales growth year-over-year and in Q4.

• Eighth consecutive quarter of adjusted EBITDA growth, with Q4 2025 adjusted EBITDA up 22% year-over-year to $29.2M and margin at 13.4% of pro forma net sales.

• Free cash flow was $16.8M in Q4 and $3.1M for FY 2025, excluding M6-related restructuring charges.

• Strategic distributor transition in the U.S. spine business led to improved performance, with top 30 U.S. distributors driving 75% of U.S. net sales by Q4.

• Launched multiple new products, including TrueLok Elevate and Fitbone, and prepared for the full market release of the VIRATA Spinal Fixation System in H2 2026.

Financial highlights

• Q4 2025 pro forma net sales were $218.6M, up 3.1% year-over-year; FY 2025 pro forma net sales were $811.9M, up 4.1% year-over-year.

• Q4 2025 pro forma adjusted gross margin was 71.4%; full-year pro forma adjusted gross margin was 71.6%.

• Q4 2025 pro forma adjusted EBITDA was $29.2M (13.4% margin), up from $24.9M (11.9%) in Q4 2024.

• Q4 2025 pro forma adjusted net income was $10.5M, up from $1.7M in Q4 2024.

• Ended Q4 2025 with $85.1M in total cash.

Outlook and guidance

• 2026 net sales guidance: $850M–$860M (midpoint $855M), representing ~5.5% pro forma constant currency growth.

• 2026 non-GAAP adjusted EBITDA guidance: $95M–$98M, with 70 bps margin expansion at midpoint.

• Positive free cash flow expected for 2026, excluding potential legal settlements.

• Long-range plan (2026–2028): 6.5%–7.5% net sales CAGR, mid-teens adjusted EBITDA margin by 2028, and sustained positive free cash flow.

• Adjusted gross margin for 2026 expected at ~72.5%.