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Cook the pasta according to package instructions.
In a large skillet, melt the butter over medium heat. Add the walnuts and sage and cook for 2-3 minutes, stirring frequently, until fragrant and lightly browned. Remove from heat and set aside.
In the same skillet, sauté the mushrooms and onion until softened, about 5-7 minutes. Add the tomato paste, garlic, and red pepper flakes and cook for 1 minute more.
Add the spinach, oregano, and nutmeg and cook until the spinach is wilted, about 2 minutes.
Pour in the vegetable broth and pumpkin purée and stir to combine. Bring the mixture to a simmer and cook for 5-7 minutes, until slightly thickened.
Drain the cooked pasta and add it to the pumpkin sauce. Stir to coat.
Transfer the pasta mixture to a baking dish and top with the Parmesan and fontina cheeses.
Sprinkle the brown butter walnut and sage topping over the top.
Bake at 375°F for 20-25 minutes, until the cheese is melted and bubbly.