Anna van der Breggen delivered the Netherlands its first gold medal of the Rio Olympics on Sunday in a nail-biting finish to the women's cycling road race, which saw her team-mate Annemiek van Vleuten injured in a nasty fall.

Van Vleuten had been in the lead when she fell while going around a rain-slicked corner in the treacherous descent to Rio, where Italy's Vincenzo Nibali and Colombia's Sergio Henao had also crashed out in Saturday's men's race. Nibali suffered a fractured collarbone and Henao was reported to have fractured part of his pelvis.

Van Vleuten was taken to a Rio hospital where "severe concussion and three small fractures in her lumbar spine" were diagnosed, according to the Dutch cycling federation KNWU.

"I am now in the hospital with some injuries and fractures, but will be fine," Van Vleuten tweeted. "Most of all super disappointed after best race of my career."

Van der Breggen said the other riders were "shocked" to pass van Vleuten, who lay motionless on the ground after taking a head-first spill off her bicycle and hitting her back on a concrete border lining the road, around 12 kilometres from the finish line.

Swedish cyclist Emma Johansson, who ended up taking silver, encouraged van der Breggen to pedal on by telling her "just do it for Annemiek," the Dutch champion said.

"After the men's race, ... we were all warned that we need to take care of that descent," van der Breggen said. "Of course, if you are riding in front, then maybe you take too much risk. I don't know. It's still a bike race and everything can happen, so it's maybe just bad luck that it happened to her."

Johansson called the crash "horrendous."

US cyclist Mara Abbott then took over the lead, but van der Breggen teamed up with Johansson and Italy's Elisa Longo Borghini to chase her down. Abbott ran out of steam just before the finish line on Copacabana beach and finished fourth, behind bronze winner Longo Borghini.

Van der Breggen, Johansson and Borghini all clocked the same time of 3 hours, 51 minutes, 27 seconds in the 137-kilometre race.

It is the first Olympics for van der Breggen, who has been competing since she was 8 years old, inspired by her older brothers.

British world champion Lizzie Armitstead had been a favourite in the competition, but lost precious time at its windswept start after having to change bicycles, reportedly because of a puncture. The 27-year-old finished fifth.

"I'm happy with the tactic I had, I just simply wasn't good enough at climbing, so I can be proud of the effort I did," Armitstead said.

She almost did not get to compete in Rio after missing three doping tests over the last year, but she successfully challenged one of them in the Court of Arbitration for Sport.

"It's been a very difficult couple of weeks," she said. "It was a victory to be here for me."

Armitstead had declared in a statement posted online on Wednesday that she is "a clean athlete" and that "it hurts me to consider anybody questioning my performances."

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