Physical Capacity Decline Begins Decades Before Sarcopenia - EMJ

Sarcopenia is increasingly recognized as a multidimensional syndrome reflecting impaired physiological reserve rather than isolated skeletal muscle loss. Although numerous circulating biomarkers have been associated with sarcopenia and adverse orthopaedic outcomes, their biological significance varies according to the underlying clinical context. This narrative review integrates current evidence on circulating biomarkers of sarcopenia and physiological reserve across elective total hip and knee arthroplasty, fragility hip fracture, community-dwelling older adults, and medically complex populations. The available evidence demonstrates that sarcopenic phenotypes differ substantially between these populations, with predominantly disuse-related muscle deterioration in elective arthroplasty, frailty-associated sarcopenia after hip fracture, and metabolically driven muscle loss in chronic systemic diseases. Nutritional (albumin, geriatric nutritional risk index), inflammatory (C-reactive protein (CRP), neutrophil-to-lymphocyte ratio, CRP-to-albumin ratio), metabolic (aspartate aminotransferase-to-alanine aminotransferase ratio, glucose-to-albumin ratio), endocrine (vitamin D, insulin-lik

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Italy’s low fentanyl death toll reflects Europe’s distinct opioid market history, not mafia restraint – but synthetic opioids such as nitazenes are a growing threat. Italy has recorded very few deaths involving fentanyl. A September 2026 article in The Economist invokes The Godfather films to suggest that ‘the country’s mafias seem to have collaborated to keep fentanyl out of their territory,’ protecting their established markets from a substance that kills customers and attracts police attention. Such a hypothesis had already been put forward by Roberto Saviano in La Repubblica. While it is an intriguing theory, there is no evidence for it. To understand the absence of an American-style fentanyl crisis in Italy as well as in other parts of Europe, we need to look at the history of opioid markets, rather than assume that godfathers hailing from unnamed ‘mafias’ are out there to protect their fellow countrypeople.

A new study suggests that even low levels of physical activity could protect the brain from Alzheimer’s disease – but not in the way scientists expected. The researchers tracked almost 300 older adults with early brain signs of Alzheimer’s for nine to 11 years using pedometers. They found that physical activity didn’t reduce the toxic amyloid plaques that most Alzheimer’s treatments now target.