Quality Investor

Xtant Medical Holdings, Inc.

Rank #9Op. Leverage

XTNT · NYSE · Healthcare

Xtant Medical Holdings, Inc. (XTNT) — Rank #9 by gross profitability (GP/assets 1.06) · ROE 12.4% · Piotroski F-Score 8 / 9.

As-of 2026-09-28 · CIK 0001453593 · all metrics point-in-time as of the filing date.

About

Xtant Medical Holdings, Inc. provides regenerative medicine products and medical devices for orthopedic and neurological surgeons in the United States and internationally.

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It offers OsteoSponge, a natural scaffold for cellular in-growth; OsteoSelect DBM Putty, a moldable demineralized bone matrix; OsteoSelect PLUS DBM Putty to deliver handling properties and ensure patient safety through validated and terminal sterilization; 3Demin, a family of allografts that maximizes osteoconductivity and the osteoinductive potential of human bone; OsteoFactor Pro, a processed allograft that contains retained growth factors found within the endosteum layer of allograft bone; OsteoVive Plus, an aseptically processed and viable bone allograft; and nanOss products that provide osteoconductive nano-structured hydroxyapatite and an engineered extracellular matrix bioscaffold collagen carrier. It also provides sports allografts for anterior and posterior cruciate ligament repairs, anterior cruciate ligament reconstruction, and meniscal repair; milled spinal allografts for cortical bone milled to desired shapes and dimensions; and traditional allografts for orthopedics, neurology, podiatry, oral/maxillofacial, genitourinary, and plastic/reconstructive applications. In addition, it offers cervical products comprising Spider cervical plating, Streamline OCT system, and CervAlign systems; thoracolumbar products, such as of Axle-X interspinous fusion, Streamline MIS spinal fixation, Streamline TL spinal fixation, and HPS 2.0 hybrid performance systems; Silex sacroiliac joint fusion systems; interbody products comprising Calix for cervical and thoracolumbar applications, Irix-C Cervical and Irix-A lumbar integrated dusion systems, and Fortilink implants; Contact ALP (Anterior Lumbar Plate) System; and interlaminar stabilization products, such as Coflex device for lumbar spinal stenosis; and CoFix implants for back and disc pain.

The company is headquartered in Belgrade, Montana.

Industry
Medical Devices
Sector
Healthcare
State
DE
Filer Category
Non-accelerated filerSmaller reporting company
Fiscal Year End
December 31

Company Snapshot

P/E and reverse DCF are the primary valuation lenses at this stage.

Market Cap

—

P/E (annual)

—

P/S (annual)

—

P/B

—

P/OCF (annual)

—

Shareholder Yield

—

Employees

151

Industry

Medical Devices

Exchange

NYSE

Signal Flags

1 yellow
Dilution above 2%Annual share count increase exceeds 2%. May be acceptable for high-growth companies funding talent via stock compensation

Quality Profile

Profitability

1/1 pass
GP / assets
1.06
Return on equity
12.4%
Gross margin trend
PASS

Safety

1/1 pass
Balance-sheet safety
PASS
Debt / equity
0.99
Current ratio
2.16×
Net cash
-$1.14M

Cash Flow

3/3 pass
Positive FCF
PASS
Cash-backed earnings
PASS
Accruals healthy
PASS
SBC / revenue
2.2%

Growth

1/2 pass
Revenue growth
14.2%
Piotroski F-Score
8 / 9
Share dilution
12.3%

Terry Smith quality gate

Passes 2/5 Terry Smith thresholds

Operating margin expansion and free cash flow are the primary reads at this stage.

Profitability

Gross profitability (GP / assets)

1.06

Primary signal (Novy-Marx).

100th pctl of 20 SIC 3841 peers

Return on equity

12.4%

Gross margin

62.9%

42nd pctl of 20 SIC 3841 peers

Revenue growth (YoY)

14.2%

Gross margin improving

Margin trend vs prior year.

PASS

Operating Leverage

2022202320242025
Revenue vs COGS
Revenue vs OpEx
Op. Income vs Revenue

Growth

Revenue CAGR (3Y)

32.2%

Revenue CAGR (5Y)

20.2%

Earnings CAGR (3Y)

—

FCF CAGR (3Y)

—

Anti-fragile safety

Balance-sheet safety

Composite anti-fragile check.

PASS

Debt / equity

0.99

14th of 19 SIC 3841 peers (best = lowest)

Current ratio

2.16×

21st pctl of 20 SIC 3841 peers

Quick ratio

0.98×

Net cash

-$1.14M

Cash & equivalents minus total debt.

Recession resistance

Revenue through recessions

Worst single-year YoY revenue decline, 16 years of history

Weak
2008-2009 (GFC)
N/AN/A
2020 (COVID)
-17.5%Significant decline
Worst year on record(any fiscal year, not recession-limited)
-17.5%Significant decline

Cash-flow health

Free cash flow

$10.16M

Operating cash flow minus capex.

Positive free cash flow

PASS

FCF / net income

1.04

Cash-backing of earnings.

FCF/NI divergence

Unfavorable divergence (yellow flag).

PASS

Accruals healthy

Cash-backed earnings.

PASS

SBC / revenue

2.2%

Stock-based comp intensity.

Piotroski F-Score

F-Score

8 / 9

Fundamental-strength score (0-9).

Lifecycle Phase History

20202025
Decline
Startup
Hypergrowth
Op. Leverage