A 35-year-old woman from Punjab presents with progressive bone pain, muscle weakness, and difficulty climbing stairs. Investigations show serum calcium 7.8 mg/dL, phosphate 2.9 mg/dL, alkaline phosphatase 120 U/L, and 25-hydroxyvitamin D level of 15 ng/mL. What is the most common cause of osteomalacia in this adult patient?

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