Vibration testing is a well-known practice for damage identification of civil engineering structures. The real modal parameters of a structure can be determined from the data obtained by tests using system identification methods. By comparing these measured modal parameters with the modal parameters of a numerical model of the same structure in undamaged condition, damage detection, localization, and quantification is possible. This paper presents a real-life application of this technique to assess the structural health of the 50-year old bridge of Tilff, a prestressed three-cell box-girder concrete bridge with variable height. A complete ambient vibration survey comprising both vertical accelerations and axial strains has been carried out. The in situ use of optical fiber strain sensors for the direct measurement of modal strains is an original contribution of this work. It is a big step forward in the exploration of modal curvatures for damage identification because the accuracy in calculating the modal curvatures is substantially improved by directly measuring modal strains rather than deriving the modal curvatures from acceleration measurements. From the ambient vibrations, natural frequencies, damping factors, modal displacements and modal curvatures are extracted by the stochastic subspace identification method. These modal parameters are used for damage identification which is performed by the updating of a finite element model of the intact structure. The obtained results are then compared to the inspections performed on the bridge.