When it comes to dynamically loaded concrete structures, determining the real degree of fatigue damage of a structure on site is a very demanding process that has not been explored in depth. Calculation concepts according to current codes and specifications (e.g. fib Model Code for Concrete Structures 2010 [1]) do not offer efficient results for this task. However, the permanent monitoring from the erection of a structure up to the end of its lifetime is seen as a very promising possibility for assessing the degree of damage constantly. This article takes a closer look at the concrete fatigue concept of fib Model Code 2010 [1], shows an FE simulation of a time-dependent fatigue process for an offshore wind turbine foundation and presents a fatigue monitoring concept including laboratory tests, which enables the detection of the real degree of deterioration in a concrete structure. During tests, the use of ultrasound was identified as the most appropriate method. Measuring wave velocity enables the determination of the dynamic E-modulus, which correlates to the degree of damage within the cross-section of the structure considered.