A ceremony in L'Aquila, northeast of Rome, remembered the dead and the 1,600 injured when the devastating quake hit in the early hours of April 6, 2009.
"The path of reconstruction has begun, but it is necessary to proceed with strength because a lot still needs to be done," Italian President Sergio Mattarella said.
"Numerous houses await renovation, vast artistic heritage has been damaged in artistic centres partly destroyed by the earthquake," Mattarella said in a commemorative message.
The quake left at least 80,000 people homeless in the rugged Abruzzo region, and the city has battled to build quake-proof housing for them in so-called New Towns.
Quake-resistant Progetto C.A.S.E. (meaning "homes project") apartment blocks now house 17,000 people.
"The wound of a local community is a wound of the national community," Prime Minister Giuseppe Conte said.
"Ten years have passed since the earthquake in L'Aquila and we still have the duty of memory: many have lost loved ones, many continue to suffer," Conte wrote on Facebook.
L'Aquila's elegant buildings and squares -- which span the medieval, Renaissance and Baroque periods -- are slowly being renovated and businesses are reopening.
The quake spurred emergency services to reorganise their disaster response in a country that is frequently struck by devastating seismic activity.
"I still have a deep memory, especially of the Red Cross volunteers from L'Aquila, struck by the devastation in their homes and their families," said Italian Red Cross president Francesco Rocca.
"In spite of everything, they put on their uniforms and set to helping their fellow citizens," said Rocca, who is also head of the International Federation of Red Cross and Red Crescent Societies.
"For the Italian Red Cross, the earthquake in L'Aquila marked an organisational, historical and human turning point that marked us deeply."