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Australia's Amanda Spratt is out of the Giro Rosa and in doubt for the world cycling titles after a crash that brought down race leader Annemiek van Vleuten.

Australian champion Amanda Spratt was lucky to escape serious injury after a crash in the Giro Rosa which also left race leader Annemiek van Vleuten with a broken wrist.

The Dutch rider is set to miss her women's road race title defence at the world championships in Imola, Italy on September 26, while Australian team leader Spratt, who has finished top three in the past two years, is also in doubt with an injured shoulder and concussion.

The Mitchelton-SCOTT pair were forced to withdraw following the crash in the finale of stage seven in Maddolini.

They were part of a select group contesting for the stage victory before going down inside the final three kilometres, unable to avoid riders falling in front of them.

Despite being able to roll across the line to finish the stage, the duo were taken to hospital for examinations with Spratt avoiding any fractures.

But she suffered a heavy hit to her right shoulder and head and was later diagnosed with concussion.

"Right now my biggest feeling is just disappointment, not just for me but for Vleuty (Van Vleuten) and the whole team," Spratt said.

"Our Giro was going perfectly, and it all fell apart in one instant.

"I think I am lucky I don't have a broken bone but the shoulder is very painful still and with a concussion I have to take it easy now.

"I hope to recover as quick as possible and be back racing soon."

Scans confirmed a broken left wrist for Van Vleuten, who will return to Holland for surgery on Saturday.

Van Vleuten was leading the overall classification with two stages to go, in an attempt to win her third consecutive overall title at the Giro Rosa.

"I'm super sad it's not possible to defend the maglia rosa, but even more, no worlds on a course that suits me," Van Vleuten said.

"I'm disappointed that I cannot defend my world champion's jersey."