In a large skillet or Dutch oven, heat over medium heat. Add the Italian sausage, breaking it apart with a spatula. Cook until browned, about 5–7 minutes.

Reduce heat to medium-low and add butter to the skillet. Allow the butter to melt and turn golden brown, about 3-4 minutes.

Stir in the pumpkin puree, broth, and uncooked pasta. Mix well to combine all ingredients and bring to a boil, about 2-3 minutes.

Once boiling, reduce heat to a simmer and cover. Cook for 10-12 minutes until pasta is tender yet firm to the bite.

Assess sauce consistency; add more broth if too thick, or simmer uncovered for 3-5 minutes if too thin.

Stir in freshly chopped sage and adjust seasoning with salt and pepper. Serve hot, garnished with Parmesan cheese.