Five children are said to be among the dead and many remain unaccounted for as a massive search for those trapped is under way.
The 6.3-magnitude quake struck at 0330 (0130 GMT) close to L'Aquila city, 95km (60 miles) north-east of Rome.
A civil protection official said 3,000 to 10,000 buildings in the medieval city may have been damaged.
And as many as 50,000 people are feared to have been made homeless.
Obviously, Italy is a very geologically active country, they have thousands of earthquakes; but earthquake prediction is still unreliable and in its infancy as a science.
The death count is likely to rise, they're still digging people out of the rubble.