Even some experts who have helped test Fosamax say this broader group is being overtreated.
It is a pill that might escape the side effects of Fosamax and Actonel.
And existing drugs, big sellers like Merck's Fosamax and Pfizer's Lipitor, are facing generic competition.
Not that Merck didn't have the goods: Vasotec, Mevacor and now Fosamax are great successes.
And there is no direct evidence that Fosamax prevents hip or wrist fractures in this broader group.
Merck's other blockbusters, such as Fosamax for osteoporosis and Singulair for asthma and allergies, continue to perform well.
Merck 's (nyse: MRK - news - people ) osteoporosis drug Fosamax may also benefit.
Worryingly for Merck, the patents on Zocor and Fosamax, two of its remaining blockbusters, will expire by 2008.
If you are one of the 8 million American women who have osteoporosis (brittle bones), one option is taking Merck's Fosamax.
Worse, this could bode badly for a European patent on Fosamax, which was prescribed 22-million times last year to prevent fragile bones.
That would be more convenient for patients than Fosamax's once weekly regimen.
Meanwhile, the patent expirations for cholesterol drug Zocor, this Friday, and osteoporosis pill Fosamax, in two years, are already baked into the stock price.
Reclast, from Novartis, is in the same chemical class as Fosamax and Actonel, but it must be given as an intravenously, directly into a vein.
Two years later, it will lose its next biggest seller, the osteoporosis treatment Fosamax--a loss resulting from a court decision that took Merck by surprise.
If U.S. Zocor sales remain flat or decline only slightly, it will be much easier for earnings to grow on the backs of Cozaar, Singulair and Fosamax.
Oral bisphosphonates -- which include drugs such as Fosamax and Boniva -- can upset the stomach and cause acid reflux, although it helps to take the medication as directed.
Bernstein's Porges has written that it may prove difficult to convince insurers to let doctors and patients try the drug unless its effectiveness and safety far outstrip that of Fosamax.
They say that so long as it is safe, the medicine is likely to become the first choice for patients for whom Fosamax proves ineffective or intolerable because of side effects like heartburn.
He called the Vioxx litigation "somewhat of a distraction" from even bigger problems for Merck: the patent expirations on cholesterol drug Zocor in 2006 and on Merck's big-selling osteoporosis medication Fosamax in 2008.
If the risk was deemed serious enough, they might even start taking osteoporosis drugs like Merck (nyse: MRK - news - people )'s Fosamax early in the bone-thinning process, he says.
The WSJ story uses as its jumping-off point the (shocking? surprising?) discrepancy between two studies that both asked the same question and used the same data: does taking bisphosphonates (think Fosamax) increase your risk of stomach or throat cancer?
FORBES: What Did You Know, and When Did You Stop Knowing It?
Late Sunday, the company released data from a second-stage trial of 411 patients showing its experimental drug AMG-162 was at least as effective at boosting bone density as Fosamax and only has to be given as little as once every six months.
Roche Holding (otc: RHHBY - news - people )is expected to release results of a big study showing that its experimental osteoporosis drug Boniva, which works by the same mechanism as Fosamax, can protect bones when given only once a month.
"Mostly it's been a discussion of the patients needing cheaper drugs and the large pharmaceutical companies wanting to maintain their prices in the U.S., " says Byron Cryer, a gastroenterologist at the University of Texas Southwestern Medical School and one of the authors of the Fosamax paper.
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