SI-BONE, Inc. Reports Record Financial Results for the Fourth Quarter 2025 and Issues 2026 Guidance
Rhea-AI Summary
SI-BONE (Nasdaq: SIBN) reported record Fiscal Year 2025 results with worldwide revenue of $200.9M (up 20.2%) and positive adjusted EBITDA of $8.9M. Fourth quarter revenue was $56.3M (up 15.0%) with positive free cash flow. The company issued 2026 guidance of $228.5M–$232.5M, implying ~14%–16% growth and an expected increase in positive adjusted EBITDA.
Other highlights include a ~79% gross margin, strategic partnership with Smith+Nephew, INTRA Ti launch, expanded physician adoption, and year-end cash of $147.8M.
Positive
- Worldwide revenue +20.2% to $200.9M in 2025
- Positive adjusted EBITDA of $8.9M for 2025
- Fourth quarter positive free cash flow of $0.4M
- 2026 guidance: $228.5M–$232.5M (~14%–16% growth)
Negative
- Net loss of $18.9M in 2025 remains a loss
- Operating expenses increased 8.9% in 2025
- Borrowings of $35.6M as of December 31, 2025
- Company expects ~12.5% operating expense growth in 2026
Key Figures
Market Reality Check
Peers on Argus
SIBN was roughly flat at +0.06% pre-release, while key peers showed mixed moves: TNDM appeared in momentum scanners and was down ~6.9%, AVNS and OFIX were modestly positive, and ZIMV was unchanged. The lack of consistent direction confirms a stock-specific setup rather than a broad medical devices move.
Previous Earnings Reports
| Date | Event | Sentiment | Move | Catalyst |
|---|---|---|---|---|
| Nov 10 | Q3 2025 earnings | Positive | -0.6% | Strong Q3 growth, higher guidance, yet shares fell modestly post-report. |
| May 05 | Q1 2025 earnings | Positive | +15.4% | Robust revenue growth and first positive adjusted EBITDA drove double-digit gain. |
| Feb 24 | Q4 2024 earnings | Positive | +5.5% | Record Q4 and FY 2024 results with positive EBITDA and solid 2025 guidance. |
| Nov 12 | Q3 2024 earnings | Positive | -15.9% | Strong growth and improved EBITDA but stock sold off sharply afterward. |
| Aug 05 | Q2 2024 earnings | Positive | +1.3% | 20% revenue growth and better losses supported a modest positive reaction. |
Earnings releases have generally been operationally positive, but price reactions were mixed: 3 aligned upward moves and 2 negative divergences, including one double‑digit drop.
Over the past five earnings cycles, SI-BONE has delivered consistent double-digit revenue growth and steadily improved profitability metrics. Notable milestones include transitioning to positive adjusted EBITDA, expanding gross margins near 79%, and repeatedly raising or updating revenue guidance. Price reactions have varied, with some strong positive responses (e.g., Q1 2025 up 15.44%) and some sharp selloffs (Q3 2024 down 15.93%), underscoring that strong fundamentals have not always translated into immediate share price strength.
Historical Comparison
In the past five earnings-related announcements, SIBN’s average 24-hour move was about 1.15%, with both strong rallies and sharp selloffs following fundamentally positive results.
Earnings history shows a progression from growing revenue with sizable losses to sustained high-70s gross margins and increasingly positive adjusted EBITDA, alongside recurring guidance raises and expanding physician adoption.
Market Pulse Summary
This announcement highlights record 2025 revenue of $200.9M, sustained high gross margins of 79.6%, and a shift to positive adjusted EBITDA of $8.9M, supported by expanding physician adoption and new partnerships. Guidance calls for $228.5M–$232.5M of 2026 revenue and roughly 78% gross margin. In context of past earnings, where strong fundamentals sometimes met mixed price reactions, investors may watch execution on growth catalysts, expense discipline, and cash balance of $147.8M as key markers.
Key Terms
adjusted EBITDA financial
free cash flow financial
AI-generated analysis. Not financial advice.
Achieves
Generates free cash flow in the Fourth Quarter 2025
SANTA CLARA, Calif., Feb. 23, 2026 (GLOBE NEWSWIRE) -- SI-BONE, Inc. (Nasdaq: SIBN), the global leader in developing procedural solutions to address clinical challenges associated with compromised bone, today reported financial results for the fourth quarter and full year ended December 31, 2025.
Fourth Quarter 2025 Financial Highlights (all comparisons are to the prior year period)
- Worldwide revenue of
$56.3 million , representing growth of15.0% - U.S. revenue of
$53.5 million , representing growth of13.9% - Gross margin of
79.0% - Net loss of
$1.6 million , representing an improvement of63.3% - Positive adjusted EBITDA of
$5.1 million , representing an improvement of176.2% - Positive cashflow from operations of
$1.7 million and positive free cash flow of$0.4 million - Ended the quarter with
$147.8 million in cash and equivalents
Fiscal Year 2025 Highlights (all comparisons are to the prior year period)
- Worldwide revenue of
$200.9 million , representing growth of20.2% - U.S. revenue of
$191.1 million , representing growth of20.6% - Gross margin of
79.6% - Net loss of
$18.9 million , representing an improvement of38.8% - Positive adjusted EBITDA of
$8.9 million , representing an improvement of$14.0 million
Recent Operational (all comparisons are to the prior year period)
- ~1,640 U.S. physicians performed a procedure in the fourth quarter, representing an increase of
18% - Entered into a strategic partnership with Smith+Nephew, an orthopedics industry leader, to distribute iFuse TORQ and iFuse TORQ TNT across Level 1 and Level 2 trauma centers nationwide for pelvic trauma
- Expanded INTRA platform with the launch of INTRA Ti in February, our newest SI joint fusion solution that provides physicians procedural flexibility and workflow efficiency in ambulatory surgery centers
- U.S. patent portfolio covering the original iFuse, including the triangular shape, extended to August 2028
Organizational Update
- Anshul Maheshwari promoted to Chief Operating Officer in addition to his role as Chief Financial Officer
- As previously announced, Nikolas Kerr was promoted to the role of Chief Commercial Officer
- Jeff Zigler promoted to Senior Vice President of Market Access and Reimbursement
“In 2025, we demonstrated the strength and scalability of our business model, delivering another year of worldwide revenue growth that exceeded
Fourth Quarter 2025 Financial Results
Worldwide revenue was
Gross profit was
Operating expenses increased
Operating loss improved by
Net loss improved by
Adjusted EBITDA improved by
Fiscal Year 2025 Financial Results
Worldwide revenue was
Gross profit was
Operating expenses increased
Operating loss improved by
Net loss improved by
Adjusted EBITDA improved to positive
Cash and equivalents were
2026 Financial Guidance
SI-BONE expects 2026 worldwide revenue to be in the range of
Webcast Information
SI-BONE will host a conference call to discuss the fourth quarter 2025 financial results after market close on Monday, February 23, 2026 at 4:30 P.M. Eastern Time. The conference call can be accessed live over webcast at https://edge.media-server.com/mmc/p/zfxy6yox. Live audio of the webcast will be available on the “Investors” section of the company’s website at: www.si-bone.com. The webcast will be archived and available for replay for at least 90 days after the event.
About SI-BONE, Inc.
SI-BONE (NASDAQ: SIBN) is a global leader in developing procedural solutions to address clinical challenges associated with compromised bone. With expertise in biomechanical design and anatomy specific innovation, SI-BONE has built a technology platform with market-leading applications centered on the spinopelvic anatomy. SI-BONE continues to leverage the deep experience in addressing the challenges of low-density bone in the sacrum to develop unique technologies that are targeting new clinical adjacencies to help improve outcomes for patients with compromised bone. Since 2009, SI-BONE has supported physicians in performing a total of over 140,000 procedures. A unique body of clinical evidence supports the use of SI-BONE's technologies, including four randomized controlled trials and over 180 peer reviewed publications.
SI-BONE® is a registered trademark of SI-BONE, Inc. ©2026 SI-BONE, Inc. All Rights Reserved.
Forward-Looking Statements
The statements in this press release regarding expectations of future events or results, including SI-BONE’s expectations of continued revenue and procedure growth and financial outlook, contained in this press release are "forward-looking" statements. These forward-looking statements are based on SI-BONE's current expectations and inherently involve significant risks and uncertainties. These risks include SI-BONE's ability to introduce and commercialize new products and indications, SI-BONE's ability to maintain favorable reimbursement for procedures using its products, the impact of any future economic weakness on the ability and desire of patients to undergo elective procedures including those using SI-BONE's devices, SI-BONE's ability to manage risks to its supply chain, future capital requirements driven by new surgical systems requiring instrument tray and implant inventory investment, and the pace of the re-normalization of the healthcare operating environment including the ability and desire of patients and physicians to undergo and perform procedures using SI-BONE's devices. Actual results and the timing of events could differ materially from those anticipated in such forward-looking statements as a result of these and other risks and uncertainties, many of which are described in the company's most recent filing on Form 10-K, and the company’s other filings with the Securities and Exchange Commission (SEC) available at the SEC's Internet site (www.sec.gov), especially under the caption "Risk Factors." SI-BONE does not undertake any obligation to update forward-looking statements and expressly disclaims any obligations or undertaking to release publicly any updates or revisions to any forward-looking statements contained herein, except as required by law.
Use of Non-GAAP Financial Measures
To supplement our condensed consolidated financial statements, which are prepared and presented in accordance with generally accepted accounting principles in the United States ("GAAP"), SI-BONE uses two non-GAAP financial measures: Adjusted EBITDA and free cash flow. Non-GAAP measures should be considered supplemental to, and not a substitute for, financial information prepared in accordance with GAAP. Adjusted EBITDA excludes the effect of items that increase or decrease SI-BONE’s reported results of operations. Free cash flow is not intended to represent our residual cash flow available for discretionary expenditures. Management strongly encourages investors to review, when they become available, the company's consolidated financial statements and publicly filed reports in their entirety. The company's definition of adjusted EBITDA and free cash flow may differ from similarly titled measures used by others.
Adjusted EBITDA excludes from net loss the effects of interest income, interest expense, depreciation and amortization, and stock-based compensation. Free cash flow is defined as net cash provided by operating activities less purchases of property and equipment. SI-BONE believes the presentation of these financial measures is useful to management because it allows management to more consistently analyze period-to-period financial performance and provides meaningful supplemental information with respect to core operational activities used to evaluate management's performance. SI-BONE also believes the presentation of non-GAAP financial measures is useful to investors and other interested persons as it enables these persons to use this additional information to assess the company’s performance in using this additional metric that management uses to assess the company’s performance.
Investor Contact
Saqib Iqbal
VP, FP&A and Investor Relations
investors@SI-BONE.com
| SI-BONE, INC. CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS (In thousands, except share and per share amounts) (Unaudited) | |||||||||||||||
| Three Months Ended December 31 | Twelve Months Ended December 31 | ||||||||||||||
| 2025 | 2024 | 2025 | 2024 | ||||||||||||
| Revenue | $ | 56,350 | $ | 49,002 | $ | 200,925 | $ | 167,178 | |||||||
| Cost of goods sold | 11,818 | 10,225 | 41,046 | 35,057 | |||||||||||
| Gross profit | 44,531 | 38,777 | 159,879 | 132,121 | |||||||||||
| Operating expenses: | |||||||||||||||
| Sales and marketing | 32,806 | 31,249 | 124,224 | 117,054 | |||||||||||
| Research and development | 4,363 | 3,870 | 17,448 | 16,560 | |||||||||||
| General and administrative | 9,825 | 9,152 | 40,537 | 33,755 | |||||||||||
| Total operating expenses | 46,994 | 44,271 | 182,209 | 167,369 | |||||||||||
| Loss from operations | (2,463 | ) | (5,494 | ) | (22,330 | ) | (35,248 | ) | |||||||
| Interest and other income (expense), net: | |||||||||||||||
| Interest income | 1,446 | 1,784 | 6,074 | 7,848 | |||||||||||
| Interest expense | (629 | ) | (795 | ) | (2,628 | ) | (3,440 | ) | |||||||
| Other income (expense), net | (2 | ) | 10 | (20 | ) | (73 | ) | ||||||||
| Net loss | $ | (1,648 | ) | $ | (4,495 | ) | $ | (18,904 | ) | $ | (30,913 | ) | |||
| Net loss per share, basic and diluted | $ | (0.04 | ) | $ | (0.11 | ) | $ | (0.44 | ) | $ | (0.75 | ) | |||
| Weighted-average number of common shares used to compute basic and diluted net loss per share | 43,507,786 | 41,994,284 | 42,959,856 | 41,466,564 | |||||||||||
| SI-BONE, INC. CONDENSED CONSOLIDATED BALANCE SHEETS (In thousands) (unaudited) | |||||||
| December 31, 2025 | December 31, 2024 | ||||||
| ASSETS | |||||||
| Current assets: | |||||||
| Cash and cash equivalents | $ | 42,240 | $ | 34,948 | |||
| Short-term investments | 105,583 | 115,094 | |||||
| Accounts receivable, net | 29,915 | 27,459 | |||||
| Inventory | 33,897 | 27,074 | |||||
| Prepaid expenses and other current assets | 4,480 | 3,204 | |||||
| Total current assets | 216,115 | 207,779 | |||||
| Property and equipment, net | 21,298 | 20,374 | |||||
| Operating lease right-of-use assets | 1,087 | 1,984 | |||||
| Other non-current assets | 55 | 300 | |||||
| TOTAL ASSETS | $ | 238,555 | $ | 230,437 | |||
| LIABILITIES AND STOCKHOLDERS' EQUITY | |||||||
| Current liabilities: | |||||||
| Accounts payable | $ | 4,631 | $ | 6,488 | |||
| Accrued liabilities and other | 19,704 | 19,492 | |||||
| Operating lease liabilities, current portion | 944 | 1,152 | |||||
| Total current liabilities | 25,279 | 27,132 | |||||
| Long-term borrowings | 35,569 | 35,452 | |||||
| Operating lease liabilities, net of current portion | 175 | 879 | |||||
| Other long-term liabilities | — | 10 | |||||
| TOTAL LIABILITIES | 61,023 | 63,473 | |||||
| Stockholders' Equity: | |||||||
| Common stock and additional paid-in capital | 626,974 | 598,074 | |||||
| Accumulated other comprehensive income | 816 | 244 | |||||
| Accumulated deficit | (450,258 | ) | (431,354 | ) | |||
| TOTAL STOCKHOLDERS’ EQUITY | 177,532 | 166,964 | |||||
| TOTAL LIABILITIES AND STOCKHOLDERS’ EQUITY | $ | 238,555 | $ | 230,437 | |||
| SI-BONE, INC. CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (In thousands) (unaudited) | |||||||
| Twelve Months Ended December 31, | |||||||
| 2025 | 2024 | ||||||
| Cash flows from operating activities | |||||||
| Net loss | $ | (18,904 | ) | $ | (30,913 | ) | |
| Adjustments to reconcile net loss to net cash used in operating activities | |||||||
| Stock-based compensation | 25,524 | 25,869 | |||||
| Depreciation and amortization | 5,770 | 4,379 | |||||
| Accounts receivable credit losses | 570 | 470 | |||||
| Inventory reserve | 1,997 | 1,300 | |||||
| Amortization of discount and premium on marketable securities | (3,051 | ) | (5,440 | ) | |||
| Amortization of debt issuance costs | 117 | 153 | |||||
| Loss on disposal of property and equipment | 1,627 | 1,877 | |||||
| Changes in operating assets and liabilities | |||||||
| Accounts receivable | (3,027 | ) | (5,840 | ) | |||
| Inventory | (8,684 | ) | (8,047 | ) | |||
| Prepaid expenses and other assets | (1,030 | ) | (2 | ) | |||
| Accounts payable | (1,763 | ) | 1,861 | ||||
| Accrued liabilities and other | 179 | 1,908 | |||||
| Net cash used in operating activities | (675 | ) | (12,425 | ) | |||
| Cash flows from investing activities | |||||||
| Maturities of marketable securities | 205,100 | 228,500 | |||||
| Purchases of marketable securities | (192,526 | ) | (205,380 | ) | |||
| Purchases of property and equipment | (8,414 | ) | (10,497 | ) | |||
| Net cash provided by (used in) investing activities | 4,160 | 12,623 | |||||
| Cash flows from financing activities | |||||||
| Proceeds from debt financing, net of debt issuance cost | — | 35,954 | |||||
| Repayments of debt financing | — | (36,000 | ) | ||||
| Final payment fee related to debt | — | (720 | ) | ||||
| Proceeds from the exercise of common stock options | 1,169 | 570 | |||||
| Proceeds from issuance of common stock under employee stock purchase plan | 2,207 | 2,154 | |||||
| Net cash provided by financing activities | 3,376 | 1,958 | |||||
| Effect of exchange rate changes on cash and cash equivalents | 431 | (479 | ) | ||||
| Net increase in cash and cash equivalents | 7,292 | 1,677 | |||||
| Cash and cash equivalents at | |||||||
| Beginning of year | 34,948 | 33,271 | |||||
| End of year | $ | 42,240 | $ | 34,948 | |||
| SI-BONE, INC. RECONCILIATION OF NET LOSS TO NON-GAAP ADJUSTED EBITDA (In thousands) (unaudited) | ||||||||||||||||
| Three Months Ended December 31, | Twelve Months Ended December 31, | |||||||||||||||
| 2025 | 2024 | 2025 | 2024 | |||||||||||||
| Net loss | $ | (1,648 | ) | $ | (4,495 | ) | $ | (18,904 | ) | $ | (30,913 | ) | ||||
| Interest income | (1,446 | ) | (1,784 | ) | (6,074 | ) | (7,848 | ) | ||||||||
| Interest expense | 629 | 795 | 2,628 | 3,440 | ||||||||||||
| Depreciation and amortization | 1,638 | 1,213 | 5,770 | 4,379 | ||||||||||||
| Stock-based compensation | 5,976 | 6,135 | 25,524 | 25,868 | ||||||||||||
| Adjusted EBITDA | $ | 5,150 | $ | 1,864 | $ | 8,944 | $ | (5,074 | ) | |||||||
| SI-BONE, INC. RECONCILIATION OF FREE CASH FLOW (In thousands) (unaudited) | ||||||||
| Twelve Months Ended December 31, | ||||||||
| 2025 | 2024 | |||||||
| Net cash used in operating activities | $ | (675 | ) | $ | (12,425 | ) | ||
| Less: | ||||||||
| Purchases of property and equipment | (8,414 | ) | (10,497 | ) | ||||
| Free cash flow | $ | (9,089 | ) | $ | (22,922 | ) | ||
FAQ
What were SI-BONE (SIBN) full-year 2025 revenue and profitability results?
How did SI-BONE (SIBN) perform in Q4 2025 on cash flow and margins?
What guidance did SI-BONE (SIBN) provide for fiscal year 2026?
What operational developments did SI-BONE announce alongside the Q4 2025 results?
How did SI-BONE's U.S. and international revenue perform in 2025?
What is SI-BONE's balance sheet position after Q4 2025 results?
