Extreme load and fatigue damage are important parameters in the structural design of offshore wind turbines (OWTs). The purpose of this study is to obtain extreme loads and long-term fatigue damage assessment of OWT structures based on measured data. In the present study, a utility-scale OWT was monitored with a dynamic response monitoring system and long-term strains of the OWT tower were collected. Based on the monitoring strain and the operational conditions of the OWT, the load and fatigue characteristics of the OWT tower were discussed. Furthermore, statistical extrapolation of the extreme load of the OWT tower was performed and the applicability of different statistical extrapolation methods was studied. The results indicate that the same probability distribution model does not apply to all wind speeds. The maximum extreme load is extrapolated in the vicinity of the rated wind speed. Finally, the relationship between short-term fatigue damage and long-term fatigue damage of the OWT structure was discussed. Superimposing fatigue from a short calculation period underestimates the long-term fatigue of OWT structures due to significant calculation period impact. Therefore, an evaluation method for OWT structures' long-term fatigue was established to improve the accuracy of long-term fatigue calculation by superimposing short calculation periods.