Existing buildings are vulnerable to damage due to adverse factors such as multi-field coupling, material degradation, and corrosion. With the help of the big data provided by the health monitoring system, the digital twin uses data analysis to diagnose the current state of the building, predict the future performance of the building, and give real-time decisions on the operations to be taken in the future according to the information provided by the data. The technical system of the digital twin, theoretical, and technical composition of structural health monitoring are described. The key problems and research paradigms of building structure health management are combed based on the digital twin model. With the breakthrough of technology, the accumulation of data, and the improvement of computing power, digital twins for building structure health management will become a trend.