Structural health monitoring is an important issue for the maintenance of large-scale civil infrastructures, especially for bridge columns. In this paper, an innovative piezoceramic-based approach is developed for the structural health monitoring of reinforced concrete columns. An innovative piezoceramic-based device, the smart aggregate, is utilized as a transducer for the health monitoring purpose. To investigate the seismic behavior of reinforced concrete (RC) bridge columns, structural health monitoring tests were performed on two bridge columns under combined reversed cyclic loading at the Missouri University of Science and Technology. The proposed smart aggregate-based approach successfully evaluated the health status of concrete columns during the loading procedure. Sensor energy plots and 3-D normalized sensor energy plots demonstrated that the damages inside attenuated the transmitted energy. Wavelet-packet-based damage index and sensor history damage index evaluate the damage development in concrete columns under cyclic loading.