There are two main causes of osteomalacia:

insufficient calcium absorption from the intestine because of lack of dietary calcium or a deficiency of, or resistance to, the action of vitamin D, or due to undiagnosed celiac disease. phosphate deficiency caused by increased renal losses.Symptoms:

Osteomalacia in adults starts insidiously as aches and pains in the lumbar (lower back) region and thighs before spreading to the arms and ribs. The pain is symmetrical, non-radiating and accompanied by sensitivity in the involved bones. Proximal muscles are weak, and there is difficulty in climbing upstairs and getting up from a squatting position. As a result of demineralization, the bones become less rigid. Physical signs include deformities like triradiate pelvis and lordosis. The patient has a typical "waddling" gait. However, these physical signs may derive from a previous osteomalacial state, since bones do not regain their original shape after they become deformed. Pathologic fractures due to weight bearing may develop. Most of the time, the only alleged symptom is chronic fatigue, while bone aches are not spontaneous but only revealed by pressure or shocks. It differs from renal osteodystrophy, where the latter shows hyperphosphatemia. Causes
The causes of adult osteomalacia are varied, but ultimately result in a vitamin D deficiency:

Diagnosis
Biochemical findings
Biochemical features are similar to those of rickets. The major factor is an abnormally low vitamin D concentration in blood serum.
In July 2021, the FDA approved insulin glargine-yfgn (Semglee), a biosimilar product that contains the long acting analog insulin glargine. Insulin glargine-yfgn is interchangeable and less expensive than the reference product, insulin glargine (Lantus), which had been approved in 2000. The FDA requires that new insulin products are non-inferior to existing insulin products with respect to reduction in hemoglobin A1c. See Misbin, RI (February 2022). Insulin - History from an FDA Insider. Politics and Prose Publishing, Washington DC. Text ISBN 978-I-62429-391-7

Research
Inhalation
In 2006 the U.S. Food and Drug Administration (FDA) approved the use of Exubera, the first inhalable insulin. It was withdrawn from the market by its maker as of third quarter 2007, due to lack of acceptance. Inhaled insulin claimed to have similar efficacy to injected insulin, both in terms of controlling glucose levels and blood half-life. Currently, inhaled insulin is short acting and is typically taken before meals; an injection of long-acting insulin at night is often still required. When people were switched from injected to inhaled insulin, no significant difference was observed in HbA1c levels over three months.