Since 2023, more e-bikes have been sold in Germany than conventional bicycles. But the number of crashes has been rising just as sharply. Doctors at The Technical University of Munich's TUM University Hospital analyzed patterns in e-bike crashes and found that older men face a particularly high risk of serious injury. The data also revealed clear patterns in the underlying risk factors.
When riding a bicycle becomes more physically demanding, bikes with electric pedal assistance open up new possibilities. "E-bikes help people with heart and circulatory problems in particular stay active despite the limitations they face in everyday life. This is a proven and effective form of prevention, which we as doctors naturally support," says adjunct teaching professor Dr. Dr. Michael Zyskowski, a senior physician in the Department of Trauma Surgery at TUM University Hospital. But for Zyskowski, the growing number of e-bike crashes is a cause for concern.
For the current study, he and his team took a close look at e-bike crash cases treated by the hospital's trauma surgery department between 2017 and 2023. In total, 103 injured e-bike riders were treated. Nearly half of them were seen in 2023 alone, the final year of the study period - a 50 percent increase over the previous year. "We are continuing to see this trend," says Zyskowski. "We are now seeing significantly more e-bike crashes throughout the year."
More than a third of the patients treated after an e-bike crash had to be admitted to the hospital. Ten percent were treated in the intensive care unit, almost all of them with severe brain injuries. These patients, almost all men, had an average age of 77. None of them had been wearing a helmet.
A chain of compounding factors
Trauma surgeons have observed similar patterns in many of these cases. "Motor assistance can also mean that riders do not realize as quickly how strenuous a ride has become - for example, that their blood sugar is dropping dangerously low," says Michael Zyskowski. In that situation, another feature of e-bikes becomes a disadvantage: their weight. At around 20 kilograms, they are harder to control than conventional bicycles if they lose their balance.
Kathrin Czoppelt / TUM Klinikum "We often see a combination of factors with serious consequences," Zyskowski says. "If e-bike riders are not wearing a helmet and are also unable to break their fall, head injuries become more likely. Many older people regularly take blood thinners because of heart and circulatory disease. Unfortunately, these medications can lead to particularly severe bleeding after an injury." Nearly half of the ICU patients in the study were taking blood thinners, compared with just over 10 percent of those with less severe injuries.
Helmets offer the best protection
Other details of the crashes also stand out. For example, while serious e-scooter crashes tend to happen in the evening or at night, e-bike riders were injured mainly during the day. "The people we treated tended to be out running errands or making other everyday trips," says Michael Zyskowski. "But that is also shaped by our location in central Munich. Hospitals closer to mountain-bike routes in the Alps would probably see different patterns."
The doctors expect a significant increase in case numbers over the upcoming Easter holidays. "My message to e-bike riders of all ages is simple: always wear a helmet - it is the simplest and most effective protective measure," says Michael Zyskowski. "Helmets could probably have prevented most of the serious head injuries and the associated intensive care treatment."
F. Aasen-Hartz, T. Resch et al., „Injury Characteristics in Pedelec Users: A 7-Year Study Highlighting Risks in the Elderly Male Population at an Urban University Hospital in Germany" . Injury (2026). DOI: 10.1016/j.injury.2025.112940
- For readability, this press release uses the term e-bikes throughout. In the original publication, the vehicles examined are referred to as pedelecs to distinguish them from electric bicycles that can also be ridden without pedaling.
- PD Dr. Dr. Michael Zyskowski is a member of the TUM School of Medicine and Health .
